Please print out this page and complete the required information in the form below. For zazenkai (one-day retreats) your form should be accompanied by a $30 check or money order made payable to the Great Plains Zen Center. For 3-day sesshins (multi-day retreats), members should pay $150, non-members $180. The fee for 7-day sesshins is $350 for members, and $420 for non-members. (Please do not send cash.) $30 of your payment will generally be considered a non-refundable deposit. For workshops, please include a check for $20. Mail the form and your payment to:

Great Plains Zen Center
PO Box 3362
Barrington, IL 60011

We look forward to practicing with you.

Retreat Registration Form

1. Name

_________________________________

2. Mailing address

_________________________________

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3. Phone Number with Area Code

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4. Email Address (Your address will not be shared with or sold to anyone, but will occasionally be used to apprise you of upcoming retreats or other important news. If you wish to opt out of email notices, please say so in the comments section below. We will respect your privacy.)

_________________________________

5. Food Allergies, dietary restrictions, disabilities, (Write "none" if you don't have any.)

___________________________________________________________________________

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6. Specify the events you're interest in. (Please include the appropriate fee for each retreat you select.)

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7. Do you need to buy an Oryoki set? ($55 to buy; $5 to rent. Due at beginning of retreat.)

(Check one.)
I want to rent an Oryoki set ____
I want to buy an Oryoki set ____
I already own an Oryoki set ___

8. Emergency contact information

Name ____________________________________

Residential Address

_________________________________________

_________________________________________

Phone number with area code

______________________________

Email Address

______________________________

9. Comments or questions.

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