Application Form

Please note we do not offer personal retreats. We suggest gaiahouse.co.uk.

If you have not read the How to Book page, please do so before filling out the form: How to Book

N.B. After you click Send, you should see this green message : Your message was sent successfully. Thanks. If you don't see this message you haven't filled out the form correctly and it will not be sent. Please review.

At the moment some forms do not come through. If you have not received an invoice from Paypal within three days, please email Marion: info@satipanya.org.uk. She will email you an Application form. Apologies for any inconvenience.

All application forms are binned after use, therefore, it is necessary to fill out the form again completely.
Bit of a chore for those who have been here before, but can't be helped. Patience!

Please!!! Fill in all fields.

Many thanks.

Please indicate which retreat you wish to book for. Please note: you may have to adjust dates for retreats longer than one week.

Name of retreat

Dates you wish to attend

Forename

Surname

Address

Town

Post Code

Country

Tel. (home)

(weekend/mobile)

Email

MaleFemale

Age

Emergency Contact

Name

Tel.

Have you attended a full week's Mahasi meditation course led by Bh.Bodhidhamma or Noirin Sheahan?

YesNo

Please say with whom and how long ago.

If you have not practised with Bh.Bodhidhamma or Noirin Sheahan, have you practised any form of meditation?

YesNo

Please give some indication of the practises and with whom.

Please note the diet is vegan. You can see the recipes on the Diet link under Retreats tab, so please read these to see if our diet would be suitable for you.

Please note we can usually only deal with common intolerances such as gluten. If your have a dietary allergy or intolerance that you think we might be able to cater for, please tell us below.

Please be specific.

Do you have any physical disabilities we need to be aware of?

Please note that our facilities are not suited for severe disabilities.

YesNo

Please be specific.

Have you a serious medical condition or have you suffered from a mental illness?

YesNo

Have you ever attempted suicide?

What was the mental illness you suffered from?

Are you on medication?

Please email the relevant teacher either to describe your condition or to ask them to phone you.

Bhante Bodhidhammabodhidhamma@satipanya.org.uk
Noirin Sheahannoirinsheahan@gmail.com
Guus Wentguus.went@gmail.com
Carl FooksCarl Fooks

You need to do this as soon as you apply for a course. All information is strictly confidential.

If travelling by car, are you able to offer a lift to other retreatants?

YesNo

Do you want come as the Assistant?

As an assistant, we do not expect payment of the deposit because you have kindly offered your time.
And as usual any further dana by you in your gift.

Your commitment is essential, for the course would be very difficult to run without an assistant and may indeed have to be cancelled.

YesNo

If you are new to Satipanya, you will be automatically put on the mailing list to receive the monthly eReminder. This keeps you up to date with events at the Retreat, changes in the Calendar and also has a Tip o' the Day to help with daily practice.

You can easily unsubscribe from the eReminder.

If coming for the first time, it is helpful for us to know how you came to hear about us

If you have been before, please enter Rtn below.

I have read and accept the Code of Conduct with all added information in Booking on the website.
I agree to abide by it while at Satipanya.

I have read how the centre is financed by donations save only for the deposit fee of £10 a day to cover basic costs.
I understand that my place on the course will not be confirmed until the deposit has been received. You will receive an invoice from Paypal. Please remember this is not refundable should you cancel.

For any further information or questions, please email Marion: info@satipanya.org.uk

Many thanks

We may need you to assist:

The main duties are: simple preparation of breakfast and lunch. When there is no Assistant, these duties are shared among the retreatants.
For more info, click here: Service

Many thanks