Mahabodhi Society of USA   *   Mindful Living Alliance

Youth Retreat Sign Up Form
 
* Fields are required for registration.
Event Title and Date:
*First Name:
Middle Initial:
*Last Name:
*E-mail Address:
*Age:
Gender: Male Female
Street Address:
City:
State:
ZIP/Postal Code:
Land phone:
Mobile phone:

*You must provide the following information if the applicant is under 18 years old.
*Legal Guardian
Last Name, First Name and Middle Initial:
*Street Address:
*City:
*State:
*ZIP/Postal Code:
*Land phone:
Mobile phone:

I, the undersigned, hereby certify that the above statements are true and correct to the best of my knowledge. I understand that Mahabodhi Society of USA and Mindful Living Alliance are non-profit organizations and the events are organized and conducted for the benefit of people like myself. I hereby waive and indemnify MBS, MLA and their staff, organizers and volunteers from any and all liabilities relate to my attendance at this event.
  You can submit only if you agree to the terms.

I agree
 
  Your registeration will be processed promptly.
Contact: events.mbs@gmail.com