功德禅林报名表 2014-05-20(简体)

PU??āRāMA MEDITATION CENTRE MEDITATION/VISIT APPLICATION FORM 缅甸功德禅林禅修/参访申请表格 YEAR 年份:________

3. Gender / 性别:? M/男? F/女 7. Date of Birth / 出生日期 (西元):D/日M/月Y/年 9. Blood Type / 血型:? AB ? A ? B ? O ? Other/其它:|? RH(+)? RH(-)

11. Marital Status / 婚姻状态? Single/单身? Married/已婚

16. Visa Type / 签证形式? L/观光? R/禅修? S/探亲? S/禅修签证? Other/其它: ___________

你曾否于南传佛法中短期出家?:? Yes/ 有, _______ Time(s)/次? No/没有

21. Ordained Under / 受戒于:? Theravāda/南传? Mahāyāna/汉传? Tibetan/藏传? Others/其它: _______

24. Ordination Status / 出家状态:? Staying With The Order/僧团共住? Living Alone/独居静修

25. Ordination Date / 出家日期(西元): D/日M/月Y/年受戒日期(西元): D/日M/月Y/年

26. Age As A Disciple / 戒腊: Year(s)/年

*28. House Phone No. / 联络号码: () *29. Mobile Phone No. / 手机号码: (

)

Phone No. / 电话号码: () Phone No. / 电话号码: ()

OTHERS 其它

33. Expected Duration of Stay / 预计逗留时间:

34. Source of Meditation Retreat Information / 禅修营讯息来源:

35. Introduced By / 介绍人:

Relationship / 关系:

Signature of Applicant / 申请人签名:

______________________________

PERSONAL HEALTH CONDITION 个人身心健康状态

We feel pleasure and appreciate towards your willingness to join this meditation practice. Pu??ārāma Meditation Centre is located among small villages in Myanmar. The health facilities or medical service there are inconvenient compared to those in the city and are much more different from foreign country. Therefore, for applicant who needs frequent or periodical medical care, please consult a doctor to ensure whether your health conditionis suitable to go oversea. Besides, please be fully prepared with the medicine which is nescessary during your stay in Myanmar, especially for long-term stay. (Note: The local telecommunication and postal service are not quite convenient.) In order to provide a better meditation environment for yourself and others, please fill the form honestly to inform the meditation centre regarding your own health condition if there is any particular health issue (For example: chronic disease, acute disease, contagion, depression, emotional problem, insomnia and etc.).

我们随喜您愿意深入与专志禅修的发心。雅凯功德禅林位于缅甸简朴乡村之间。健康与医疗设施和救护系统大大不如城市便利,并且与外国不同。因此,对于需要常时或定时给予医护的申请人,请务必咨询专业医生以确认出国赴缅甸禅修之可行性,并备妥一切长期所需之医护药品。(注 :当地电话通讯、邮递系统不甚方便。)

为了维护您个人及僧团最佳的禅修状态,若您有任何身心健康方面的特殊情形(如:慢性病、急性病、传染性、压力调适、情绪问题、习惯性失眠、等等),请务必如实地在表格上填写以告知禅修中心。

35. Please tick one regarding your health condition. 对于您的身心健康状态,请打勾。

? Healthy 健康? Average 尚可? Medical Care Needed 需医护

If medical care is needed, please classify: 若健康需医护,请说明:

? Physiological Aspect 身体方面: _______________________________________________

? Psychological Aspect 心智方面: _______________________________________________

(Note: To ensure the Visa laws and regulations are co-operated, every meditator or visitor must inform the meditation centre and the relevant visa authority in advance about all the activities and schedules to be carried out in the region of Myanmar but outside the meditation centre during the whole stay in Myanmar. In addition, please inform the meditation centre about the confirmed arrival date to and departure date from Myanmar. The meditation centre will not responsible for any personal behaviour or activity of all meditator and visitor.

(注:为了配合签证相关法规作业,所有禅修/参访申请者,于入境缅甸后至向道场报到前及离营后至返国前,必须事先清楚告知禅修中心及签证承办人员关于一切在缅甸境内的活动与行程,以及赴缅与返国的确定日期和时间。禅修中心恕不负责禅修/参访申请者一切个人的活动行为。)

With signing this application form, I, (Name) _____________________________ confirm that all the information given is true. In addition, I am willing to obey all the Law of Myanmar, the living rules and schedules in meditation centre, and the decision made by the meditation organizer, including the end date of the meditation retreat and the departure date from the meditation centre.

于签署此禅修/参访申请表,我,(姓名)_____________________________ 确定上述一切资料如实,并且愿意遵守一切缅甸国内的相关法规、禅修中心的共住规约、生活时间表及禅修指导老师所授予的一切禅修指示,包括结束禅修营及离营的日期和时间。

Signature of Applicant 申请人签名:________________________ Date 申请日期 : _________________

Required Documents / 所需文件:

1. A passport-sized photo (to be affixed to first page of this form). 一张护照相片(贴在此表格首页)

2. A copy of your passport details. 一张护照影印本。

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