2019 Yamantaka Drubchen (3/28-4/3) Registration Form Drikung Rinchen Choling (4048 E. Live Oak Ave., Arcadia, CA 91006) your information; all information provided are for registration purpose only and will not be shared w/ the public. PRINT ＊Please Name Gender Dharma Name Phone # Address Fax # Ｅ-mail Emergency Relationship Contact Phone # Health Please note any special health care needs: condition Guru： Lineage： Please describe your drubchen/retreat experience (what retreat, days, & experience): Practice Have you been to Yamantaka No; Places and number of Yamantaka drubchen? □ Yes; □ drubchen attended: USA_____ times; Other Country:_______ times Peaceful Manjushri mantras transmitted by: ____________________ Mantra (OM WAM GI SHWARI MUM) Lineage：_________; Number accumulated：_________（for first time participants, you on will need to to accumulate 600,000 times） complete at least 100,000 times, it’s preferable I_______________ have read the instruction and regulation of the Yamantaka Drubchen and I agree with the regulations. Once I am accepted into the Yamantake Drubchen starting March 28, I will not leave the Drubchen until it is completed on April 3. If I cancel the registration, the nonrefundable and nontransferable deposit will be donated to sponsor the Signature Drubchen. Signature: ________________________________________ Date: __________________ NOTE: On-site parking is extremely limited. Please car pool w/ others, thank you.
2019 Yamantaka Drubchen (3/28-4/3) Registration Form Drikung Rinchen Choling (4048 E. Live Oak Ave., Arcadia, CA 91006) ＊Please PRINT your information; all information provided are for registration purpose only and will not be shared w/ the public. Name Gender Dharma Name Phone # Address Fax # Ｅ-mail Emergency Contact Relationship Phone # Health condition Please note any special health care needs: Practice Guru： Lineage： Please describe your drubchen/retreat experience (what retreat, days, & experience): Have you been to Yamantaka drubchen? □ Yes; □ No; Places and number of Yamantaka drubchen attended: USA_____ times; Other Country:_______ times Mantra Peaceful Manjushri mantras (OM WAM GI SHWARI MUM) transmitted by: ____________________ Lineage：_________; Number accumulated：_________（for first time participants, you will need to complete at least 100,000 times, it’s preferable to accumulate 600,000 times） Signature I_______________ have read the instruction and regulation of the Yamantaka Drubchen and I agree with the regulations. Once I am accepted into the Yamantake Drubchen starting on March 28, I will not leave the Drubchen until it is completed on April 3. If I cancel the registration, the nonrefundable and nontransferable deposit will be donated to sponsor the Drubchen. Signature: ________________________________________ Date: __________________ NOTE: On-site parking is extremely limited. Please car pool w/ others, thank you.
2019_LA%20Yamantaka%20Registration%20Form_EN.docx