The Transformational and healing power of Jinas **Order Retreat**

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1 Welcome

2 Rates

3 Your details

Phone *
Address *	please select "‘Other/International" as State/Prov.
Address 2
City *
State/Prov. *
Zip/Postal *
Country *
Gender *
Date of birth *
Requested Roommate
Single room booking request	I want to request a single roomWe have several single rooms, but we can only accept reservations in the case of significant medical conditions. If you have particular needs, please contact us for clarification before booking.
Please tell us more about your single room needs *
Do you have any Diet Requirements? *	No Yes We offer a well-balanced vegan diet. If you have diet restrictions for genuine medical needs please provide information below.
Diet Requirements	To assist our cooks, please restrict requirements to absolutelly essencial items only.
Restricted Diet Notes	Please share any further details you'd like us to know about your diet requirements.
Any Health Information We Need to Be Aware of? *	No Yes Are there any physical, emotional or mental health issues which could affect your participation in the retreat? If you have questions or concerns, please contact us.
Health Information Notes	All information is confidential and will only be communicated to the retreat team, so they can best support you on the retreat.
What is your Triratna Buddhist Community Experience? *
Please tell us more about your meditation experience *
Emergency Contact Information *	Please give a name and phone number of someone we could contact on your behalf in case of an emergency.
How will you be arriving at Vajraloka? *
Alternative way of arriving
What is your car plate/registration number? Is a car or a van?	Please let us know if your vehicle is a van or a big size one. That will help us to sort out our car park accordingly.
Vajraloka News *	I would like to receive Vajraloka’s quarterly newsletter and very occasional other news by emailWe won't fill your inbox with our emails, promise!
Terms and Conditions *	I accept the Vajraloka terms and conditions.Please read the terms and conditions
Booking and Cancellation Policy *	I understand Vajraloka's booking and cancellation policyRead our booking and cancellation policy here.
How did you hear about us?
Gift Aid - for UK tax payers only	I am a UK taxpayer and would like Vajraloka (FWBO CORWEN) to reclaim the tax on all donations I have made in the last four years and for all future gifts of money that I make to be Gift Aid donations.With Gift Aid, any donations you make will be worth 25% more at no extra cost to you. You must be a UK taxpayer and understand that if you pay less Income Tax and/or Capital Gains Tax in the current tax year than the amount of Gift Aid claimed on all of your donations across all Charities, it is your responsibility to pay any difference.

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4 Donate to our Bursary Fund

£	Give the Gift of a Retreat Help others who can’t afford to come on retreat. Could you make a donation towards our bursary fund? Donations go directly to helping others get on retreats at Vajraloka.

5 Security Check

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6 Payment

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	Your registration will be complete once we receive your payment. If paying by Bank Transfer, pay to: Account name F W B O Account type Business Current Account number 13211080 Sort code 52-21-51 IBAN GB27NWBK52215113211080 BIC NWBKGB2L and drop us an email when the payment has been made. If paying by cheque, make cheques payable (in pounds sterling) to: FWBO (Corwen). Send your cheque and a brief note with your name and retreat name to: Retreat Bookings Vajraloka Tyn-Y-Ddol Corwen Denbighshire LL21 0EN Click on the button below and these instructions will be repeated on the next page.

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