Dharma Study Application Form

For those who are serious about liberation -- “the heart's sure release” (as the Buddha called it) -- the importance of having a solid grounding in Dharma teachings cannot be overemphasized.

Everyone is welcome. Please see below to register. The course fee does not include cost of books required.

Please note that all questions with an asterisk must be completed for your form to be accepted. Carefully fill out the form and do not omit anything.

You will receive an e-mail acknowledging receipt of your application upon successful completion of this form.

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Enter Email Confirm Email

Registration Fee*

Dharma Study Program Registration Fee

Regular
SIMT Supporter

When would you like to pay?*

Now (with my credit card)
By cheque

The following total will deducted from your credit card.

Please mail a cheque to:
Satipanna Insight Meditation
P.O. Box 167
Bethany, ON L0A 1A0

Total

$ 0.00 CAD

Credit Card

Card Details

Cardholder Name

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Dharma Study Program Application Form

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