* These fields are required

1 Welcome

Please fill out your details and press Continue.

First Name *

Last Name *

Email *

Confirm Email Address *

Save my progress and send me an email reminder

Continue

2 Donate

Sorry, but this program only has 0 spaces available. You cannot add more people. Try a different program or different dates.

Select a price option *

	$95.00 – Tier 1 (Reduced Price)
	$120.00 – Tier 2 (Regular Price)
	$145.00 – Tier 3 (Sustainer Price)
	$ Please enter an amount *

Continue

3 People in your group

Guest 1		First Name* Last Name* Email* Phone Gender*
Guest 1		First Name* Last Name* Email* Phone Gender*

Continue

4 Participant Info

Phone
This retreat is hybrid. Are you applying to attend in-person or online?	Online In-person Hybrid event Please indicate whether you plan to attend in-person or online via Zoom. A Zoom link will be shared with all registered participants prior to the program.
How did you hear about this retreat?	I've been to Tallahassee Chan Center events and retreats before Online group Social Media From someone who attended an event here before From another Buddhist teacher This option does not show up on mobile devices.
When were you born? *
Gender *

Continue

5 Practice Background

How many years have you practiced Buddhadharma? Please also include a description of your practice history. *
Do you practice meditation regularly? If so, how often?	Daily Weekly Irregularly Never Other This option does not show up on mobile devices.
What is the primary lineage within the Buddhist tradition that you have practiced under? *
Have you studied with other meditation teacher(s) before?	Yes No
Who have you studied with?
How long have you studied with them?
Have you ever taken a class at the Tallahassee Chan Center or by Guo Gu (Dr. Jimmy Yu)?	Yes No
Which class(es) have you taken from the Tallahassee Chan Center?	Please list all classes taken, and whether that class was from the online Tallahassee Chan Center Courses, or taken in-person.
Have you read anything by Guo Gu before?	Yes No
What books or articles have you read by Guo Gu?
What meditation methods do you use?
Have you taken the Three Refuges and Five Precepts in Buddhism?	Yes No
Under which teacher did you take refuge and precepts with? *
Have you done a 7-day or longer intensive meditation retreat? *	Yes No
What is the date of your last 7-day or longer intensive meditation retreat? *
Have you done retreats with the Tallahassee Chan Center before?	Yes No This option does not show up on mobile devices.
Why do you want to come on this retreat? Please also include any additional comments about your practice below.

Continue

6 Health & Accessibility

Do you have any medical issues? *	You must complete this portion of the retreat application even if you have informed us of medical issues before. Please include the information again. We request the following information to help us determine whether or not participation in a retreat will aggravate a serious medical condition, endanger a participant's health, or disrupt the functioning of a retreat. The information provided will be kept strictly confidential to protect the applicant's privacy. Please include: Serious back or leg ailments Joint or disc degeneration, or any replacement surgeries Dizziness, palpitation, or shortness of breath due to meditation High or low blood pressure Heart problems Major surgery or infectious disease If you have been treated for serious emotional or psychological symptoms If you have none, please write 'none.'
Do you have any allergies? *	Please list any new or old allergies.
What are your allergies? *	Please note all allergies, including dietary, medication or plants.
How can we support you if you have an allergic reaction? *
Do you have any dietary restrictions? *	We provide breakfast, lunch, and dinner during the retreat and need to know any dietary restrictions of concern.
Do you need any meditation supports as far as a chair or bench? Is there anything you'd like us to know about your preferences for seating? *	There will be lengthy periods of meditation in this program so please let us know if you require a special type of meditation support.
Do you snore or have any nighttime breathing issues we should be aware of (e.g., CPAP use)? *	Yes No
Do you have any accessibility or medical equipment needs we should be aware of? *	For example, do you use a cane, or require placement near an outlet for a CPAP machine? If so, please let us know below.
Comments or Special Needs

Continue

7 Contact Information

Your Home Address
Address 2
City
State/Prov.
Zip/Postal
Country
What is your emergency contact's phone number? *
What is your emergency contact's name? *

Continue

8 Extra Contribution

Offer a Little Extra to Help Us Grow

$

Continue

9 Security Check

Security check

Continue

10 Payment

Tallahassee Chan Center

Donation-Based Retreat Registration

All of our offerings are donation-based and offered on a sliding scale.

Please contribute what you can. Please contribute the highest Tier you are able to afford.

Please let us know if you would like to request a scholarship.

Payment Plan Options

We offer a default monthly payment option:

Pay a deposit, followed by 4 monthly payments

If you need a different payment arrangement (such as extending to 6 months), please don’t hesitate to email us. We are happy to work with you.

You can enable this option at the end of the form under the ‘Payment’ section, next to the ‘Pay’ drop-down button.

Discount code

Payment processing fee	I agree to cover the costs of processing this registration by paying the payment processing fee. 3.5% credit card transaction fee is included so 100% of your payment goes to the Tallahassee Chan Center. Thank you!
3.5% Payment processing fee	$0

Sub Total	$0

Donations	$0

Taxes	$0

Deposit	$0
	$0 next payment date * last payment amount will be $0

Due Now	$0 $0

Remaining Balance	$0

Choose Payment Option

	Your registration will be complete once we receive your payment. Click on the button below and these instructions will be repeated on the next page.

	You will be asked for payment details in the next step. Click the button below to continue.

Continue

	By submitting payment, you authorise Tallahassee Chan Center to send instructions to the financial institution that issued your card to take payments from your card account in accordance with the terms of Tallahassee Chan Center's agreement with you.