Skip to content
HOME
ORGYAN OSAL CHO DZONG
THE BUDDHIST PATH
TEACHERS
H. H. PEMA NORBU RINPOCHE
H. H. KARMA KUCHEN RINPOCHE
KHENTUL GYANGKHANG RINPOCHE
MUGSANG KUCHEN RINPOCHE
KHENCHEN PEMA SHERAB RINPOCHE
KHENCHEN TSEWANG GYATSO RINPOCHE
VEN. PELING TULKU RINPOCHE
KHENPO TENZIN NORGAY RINPOCHE
NYINGMA BUDDHISM
THE PALYUL LINEAGE
PRACTICES
GIVING
Search for:
HOME
ORGYAN OSAL CHO DZONG
THE BUDDHIST PATH
TEACHERS
H. H. PEMA NORBU RINPOCHE
H. H. KARMA KUCHEN RINPOCHE
KHENTUL GYANGKHANG RINPOCHE
MUGSANG KUCHEN RINPOCHE
KHENCHEN PEMA SHERAB RINPOCHE
KHENCHEN TSEWANG GYATSO RINPOCHE
VEN. PELING TULKU RINPOCHE
KHENPO TENZIN NORGAY RINPOCHE
NYINGMA BUDDHISM
THE PALYUL LINEAGE
PRACTICES
GIVING
Search for:
Personal Retreat Application
Barbara Bailie
2018-06-20T10:26:44-04:00
Personal Retreat Application
Name
*
First
Last
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Phone
*
Email
*
Date of Birth
*
Gender
*
Male
Female
When would you like to come – please include duration of the retreat you would like to do: two weeks, 20 days etc.?
*
Please tell us why you would like to do a personal retreat at Orgyan Osal Cho Dzong.
*
Which practice center(s) are you affiliated with?
As there will be little contact with others during your retreat, it would be helpful to know more about your practice background. How long have you been practicing?
*
What kind of practice do you do?
*
What retreats have you done?
*
Have you done a solitary retreat before? If so when and where?
*
Have you taken refuge? If so, with whom?
*
Do you have any current health issues that would prevent you from keeping a solitary retreat during your stay? Please also list any medications you might be currently using, allergies that you might have, dietary restrictions, etc.
*
Do you have, or have you ever suffered from anxiety, panic attacks, bi-polar disorder, mental illness, etc.? If yes, please give details
*
In the case of an emergency, who could we contact? (Please give name, phone, address, email)
*
Terms and Conditions
*
I voluntarily agree that I am responsible for my own personal, physical, and emotional well-being during this retreat. I shall not hold The Palyul Foundation of Canada, Orgyan Osal Cho Dzong, the Teachers of Orgyan Osal Cho Dzong, the Palyul Foundation of Canada Board of Directors, the property owners, or any of their agents, representatives, or volunteers responsible for any damage to me or my property.
Go to Top