Teachings offered by Upasaka Culadasa

First-Time Retreatant Form

Cochise Stronghold Retreat

Meditation Retreat with Upasaka Culadasa

First-time Attendee Application Form

PDF Version of this Form

WORD Version of this Form 

This form is for applicants attending retreat with Upasaka Culadasa for the first time.  We respectfully request that you answer all questions completely and honestly. This form is confidential and will be seen only by the retreat teacher and his wife, and will be destroyed at the end of the retreat.

 

Name:

 

Phone:

 

Email:

 

Previous meditation experience:

Have you meditated before?

If so, how long (months or years) have you been regularly practicing meditation?

 

Describe your current daily practice (frequency, duration, and type of practice):

 

 

Please provide dates, locations and teachers and styles of previous retreats you have attended. Attach additional sheet if necessary.

 

 

List dates, style of practice, duration, and locations of any intensive meditation practice in self-retreats: Attach additional sheet if necessary.

 

 

Please write a detailed statement describing your intentions for practice. Attach additional sheet if necessary.

 

 

Other Information:

Please answer all questions. You will not be denied the opportunity to attend the retreat due to your responses to these questions, but we may need to ask for additional information or discuss special arrangements.

 

Have you ever been diagnosed with a psychological condition or mental illness?

If so, please describe:

 

 

Do you have any history of physical illness or limitations that might be aggravated by or interfere with sitting and walking meditation?

If so, please explain and describe any special needs you have:

 

 

Do you have any physical limitations that would prevent you from participating in the daily work period?

If so, please describe:

 

 

Please note:

– The retreat is a silent environment. Long-term retreatants need to be at ease with both silence and solitude.

 

– There will be no opportunity to leave the retreat site for routine medical treatment or procedures and we will not be able to fill prescriptions for you.

 

– For extended retreats we will be able to arrange grocery shopping for you during your retreat should you leave us a note and money for groceries.

 

Of Special Interest

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