PBC-TN
PREREGISTRATION BY CHECK
2005 FALL RETREAT

Please print and mail this completed form along with your check to the address below or turn it in at the Nashville center by October 15.

Padmasambhava Buddhist Center
PO BOX 120633
Nashville, TN 37212
Attn: Retreat

REGISTRATION is required for all events at Padma Gochen Ling. You may fill out this form and turn it in at the Registration Table at retreat or pick up a form upon arrival. If you’d like to pre-register, send it by mail by June 1 or turn it in at the Nashville center. Pre-registration is not required but will help us plan for meals.

RETREAT FEE
NonMembers : $35 for Saturday, $50 for Sunday.
PBC Supporting Members: $30 for Saturday, $45 for Sunday. (equivalent to a 10% discount)
College students & children under 18:
$20/day

Please make checks payable to PBC.
Your donation is 100% tax deductible minus $5 for meals and is greatly appreciated.

PBC SUPPORTING MEMBERSHIP
Please note that the 10% member discount applies only to those who are currently committed to monthly or yearly memberships at any of the Padmasambhava Buddhist centers. Memberships are a vital component of the functioning of our centers. Suggested membership is $25/month or $40 per family.

If you wish to become a member, click here. We encourage all to join us as members and suport the Buddha, Dharma, and our Rinpoches' work.

Name(s): ____________________________________________________________

_____________________________________________________________________

Address:_____________________________________________________________

City: ___________________________________ State:_____ Zip: _____________

Phone:__________________________

Email:___________________________________________________________

In case of emergency, please notify (name and phone number):

____________________________________Tel_______________________

I am a supporting PBC member according to the national policy.

HOLD HARMLESS AGREEMENT
Participation in any PBC activities and/or use of any PBC facilities, including but not limited to Padma Gochen Ling, involves a risk of accidental injury despite all safety precautions. I/We, assume all risks and release from responsibility and agree to indemnify and hold harmless the Padmasambhava Buddhist Center, Padma Gochen Ling, their officers, directors, volunteers and members, for any illness or injury to the individual(s) listed above, occurring during use of any facilities or participation in any activities conducted by the Padmasambhava Buddhist Center of Tennessee.

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