3-Day Meditation Retreat

3-Day Meditation Retreat

📝Registration Form
🎬 Be Part of Something Meaningful

Thank you for your interest in this rare opportunity. You are invited to join an immersive two-day retreat at Nan Tien Temple as a core participant in a global documentary project. Your presence will help authentically share the benefits of meditation with the world. This fully-sponsored experience includes all retreat activities, meals, and twin-share accommodation.
Please note: Submitting this form does not guarantee acceptance.
Participants will be selected, and only successful applicants will be notified. By applying, you confirm that you have disclosed all relevant health conditions that may affect your participation.
Full Name*
Gender*

MaleFemale
Date of Birth*

MonthDayYear
Date
Mobile Number*
Email *

Confirmation EmailConfirm email. example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Ethnicity*
Occupation*
Car Rego
Emergency Contact Person*
Relationship*
Emergency Contact Mobile Number*
ACCOMMODATION PREFERENCE*

Standard Option: I accept the complimentary twin-share accommodation. (room allocations will be made based on gender).Upgrade Option: I request a single room and understand I will be required to pay the full accommodation fee upon acceptance.
HEALTH & WELLBEING

(Information provided is confidential and used solely for your safety and well-being during the retreat)
Do you have any health conditions (including any known or existing physical, medical or mental health conditions, allergies, etc.) ?*

YesNo
If Yes, please specify:*
Are you taking any medication we need to know for health reasons?*

YesNo
If Yes, please specify:*
Do you have any dietary requirements or allergies? (e.g., vegan, gluten-free, nut allergy)*

YesNo
If Yes, please specify:*
Severity of Reaction:

Mild (e.g., minor itching, slight discomfort)Moderate (e.g., rash, gastrointestinal symptoms)Severe (e.g., difficulty breathing, anaphylaxis)
Are you able to do the following without causing injury to yourself or others and without experiencingdiscomfort (please tick the appropriate box to confirm that you are able to perform the requisiteactivity):*

Walking meditation (20 minutes)Sitting meditation (20 minutes)No
If No, please specify why:*
Health Disclosure

I confirm that I have disclosed all known physical, medical, or mental health conditions that may affect my participation. I understand that I may be asked to obtain medical clearance from a doctor before attending.
PARTICIPANT PROFILE & CONSENT

(Your answers help us ensure this is the right fit for you and the project)
Uniform Size (for retreat attire)*

XSSMLXLXL *For your personal comfort, we recommend that you bring your own set of grey track pants/leggings.XXL *For your personal comfort, we recommend that you bring your own set of grey track pants/leggings.
Please attach a recent, clear headshot photograph. This helps the production team plan filming and ensure participants are represented authentically in the documentary.*

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Q: What is your previous experience with meditation or mindfulness practices?*
Q: Why are you drawn to this retreat, which is being filmed for a documentary?*
Q: What does “mindfulness” or “inner peace” mean to you personally, and what do you hope to gain from this retreat?*
AGREEMENT & COMMITMENT*

I understand this complimentary retreat is part of a documentary project and I agree to participate fully in all scheduled filming, photography, and interviews.I grant permission for the use of my image, voice, and likeness for promotional and educational purposes by the organizing body.I understand that this is a free retreat for twin-share accommodation, and that a single room will require full accommodation payment.I confirm I am in suitable physical and mental health to participate in activities such as seated meditation, walking meditation and Tai Chi.I agree to cooperate fully with retreat guidelines and instructions from monastics and the production team.
Terms & Conditions
Please read the Terms & Conditions in the PDF file above

I have read and agree to the retreat’s terms and conditions, including accommodation guidelines, Noble Silence, dietary requirements, and gender-based seating arrangements. I understand that Nan Tien Temple reserves the right to accept or reject applications, and to remove participants who do not follow retreat guidelines.
Signature*

Clear
Date Signed*

MonthDayYear
Date
Successful applicants will be notified via email. Please ensure your email address is correct. Thank you for considering this rare and meaningful opportunity.
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3-Day Meditation Retreat

🎬 Be Part of Something Meaningful

HEALTH & WELLBEING

PARTICIPANT PROFILE & CONSENT

Successful applicants will be notified via email. Please ensure your email address is correct. Thank you for considering this rare and meaningful opportunity.