World Dharma Retreat Online Application Form Maui, Jan 7 – 11, 2015 Name Address City State/Provence Country Zip / Postal Tel Email Website Nationality Passport valid though 2015? YesNo Livelihood How did you learn about the retreat? And are you registered in our online Course through WDOI? Please explain in a sentence or two why you wish to attend the retreat. Please list any previous retreats with Alan (if more than two, the last two only): Please list any special needs that you may have during the retreat. How will you pay for the retreat? Pay Pal? Credit Card? Check? Other? Pay PalCredit CardCheckOther If you need a personal payment plan, what is the best plan for you? Name and phone contact in case of emergency Δ Please allow 24 hours to look over your application.