Three Refuges Five Precepts Form - International Buddhist Society

First Name

Last Name

Chinese Name

Email

example@example.com

Phone Number

Format: (000) 000-0000.

Gender

Age

Languages

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

The Three Refuges

Five Precepts

Dharma Name (If already taken Refuges)

Date of Taking Refuges

Date

Name of Teacher

If you are taking the Three Refuges, you will need a Buddhist black robe. If taking the precepts, you will need a Buddhist black robe and a Precepts Sash.

Do you require a Buddhist black robe or Precepts Sash?

If yes, please select the item(s) you need:

Height :

Weight :

Are you interested in volunteering?

If yes, please select the area you are interested in volunteering for:

Remarks

Date

Signature