Application for Events with His Eminence Dzogchen Rinpoche

Thank you for taking an interest in the teachings of His Eminence the 7th Dzogchen Rinpoche, Jigme Losel Wangpo. Dzogchen Rinpoche is the holder of the 400-year-old lineage of Dzogchen and due to the precious nature of these teachings, it is important for Rinpoche to have a clear view of your spiritual history.

Please complete all sections of this application form before submitting.

Error: Events - you must select one event, and one event only.

Error: Missing details - please complete all sections of the form.

Error: Photo - no image has been selected.

Error: Photo - the format of the image you have selected is not supported.

Error: Photo - the size of the image you have selected is too large.

Error: Photo - the dimension of the image you have selected is too small.

Error: Declaration - the declaration must be accepted (ticked).

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Please select the event you would like to attend (only select one)

Three-Day Seminar in Adelaide - ATTENDANCE IN PERSON

Friday 26th April to Sunday 28th April 2024

Clear Mind Dzogchen Centre, Adelaide

AU$ 690 (Concession AU$ 640)

contact: sa@shenpenaustralia.org

Three-Day Seminar in Brisbane - ATTENDANCE IN PERSON

Saturday 22nd June to Monday 24th June 2024

Quality Hotel Robertson Gardens

AU$ 690 (Concession AU$ 640)

contact: qld@shenpenaustralia.org

Personal Details

First Name:
Last Name:
Occupation:
Date of Birth:
/ /
Age:
Gender:
Male Female Other
Address:
Town / Suburb:
County / State:
Postcode / Zip:
Country:
Phone:
Email:

First Retreat / Seminar

Is this your first Retreat / Seminar with H.E. Dzogchen Rinpoche? No Yes

Photo

If this is your first Retreat / Seminar with H.E. Dzogchen Rinpoche, you will need to upload a photo.
Please upload a standard passport photo of yourself.
The file must be one of the following formats - jpg, jpeg, gif or png.
The file must not be larger than 250kbs.

Emergency Contact

Name:
Relationship:
Phone:

Spiritual Details

Do you follow any spiritual tradition or lineage? If so, since when?

Tradition:
Year:
Who is your root (main) teacher?

Are you presently doing any spiritual practices? If so, which?

When did you first connect to H.E. Dzogchen Rinpoche and how or through whom did you make the connection?

How did you hear about this retreat / seminar?

Publicity Email
Facebook
Dzogchen Monastery / Shenpen website
Poster / flyer
Magazine / newspaper
Word of mouth
Other :

Why would you like to attend?

Other Details

The following information is helpful for the Seminar Coordinators to know in case of a medical situation:

Do you have any health conditions that might come up during your participation?

1. Allergies? No Yes

If yes, please specify:

2. Cardiovascular / cardiac condition? No Yes

If yes, please specify:

3. Respiratory condition? No Yes

If yes, please specify:

4. Psychiatric or neurological illness? No Yes

If yes, please specify:

5. Other past or current illnesses? No Yes

If yes, please specify:

6. Do you have any special needs that you would like us to know about? No Yes

If yes, please specify:

Declaration

All information given by you on this application form is regarded as strictly private and confidential within Shenpen International and will not be distributed to any other persons or organisations.

We advise that you take out medical and any other relevant insurance for the duration of the retreat/seminar. Any medication prescribed by your doctor should be continued as prescribed throughout the retreat/seminar. Applicants with a past history of psychiatric illness or chronic illness, who have received or are receiving psychiatric or medical treatment at present, are required to consult their psychiatrist or doctor and obtain medical clearance prior to applying. Shenpen International cannot accept responsibility for personal accidents, injuries, illnesses, exacerbation of existing medical conditions or loss/damage to your personal property during these events.

I would like to receive emails regarding the activities of H.E. Dzogchen Rinpoche and Shenpen. (OPTIONAL)

I have understood the above and confirm that all information provided on this form is true and correct.

Error: Events - you must select one event, and one event only.

Error: Missing details - please complete all sections of the form.

Error: Photo - no image has been selected.

Error: Photo - the format of the image you have selected is not supported.

Error: Photo - the size of the image you have selected is too large.

Error: Photo - the dimension of the image you have selected is too small.

Error: Declaration - the declaration must be accepted (ticked).

Error: ReCaptcha - you must select the ReCaptcha.