November genzo-e registration

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1726 S. Olive St., Bloomington, IN 47401

Registration for November Genzo-e at the TMBCC

* Indicates required field

Name *

First

Last

Phone Number *

Dates I will attend: *

I will be coming from out of town. *

Yes No (Skip to next section)

If applicable: Date and time I will arrive at my TMBCC or Sanshin accommodations: *

If applicable: Date and time I will depart my TMBCC or Sanshin accommodations: *

I will stay: *

In a cottage at the TMBCC; I've made my reservation and payment. In a sleeping room at the TMBCC; I've made my reservation and payment. In my own tent on TMBCC's grounds. In Sanshin's dorm; I've made my reservation and payment. In Sanshin's zendo with my own bedding; I've made my reservation and payment. In my own tent on Sanshin's grounds I will make my own arrangements to stay elsewhere.

If staying in a cottage, a sleeping room or the dorm: Please assign me to a: *

Men's sleeping room Women's sleeping room

I'd like to share accommodations with (names of participants): *

I have the following medically necessary dietary restrictions: *

None Gluten Dairy Soy Peanuts

Other dietary issues: *

Please note that we may not be able to accommodate all dietary restrictions. If you are concerned about your ability to eat what is served to everyone, you are welcome to bring and prepare your own meals.

In case of emergency, contact: *

Name: Telephone: Email

Email *

Phone Number *

Submit