Vipassana Meditation Center, Shelburne Falls, MA 01370, USA
Conference Registration Form
Please use the following form to register for Insights from an Ancient Tradition: Medicine, Science & Spirituality in the Light of Vipassana Meditation, September 3 - 4, 2000. Accommodation for the conference is limited—register early.

To apply for the preconference meditation retreat, please read the Code of Discipline and then complete a separate application form (use Massachusetts, 8/23/2000 - 9/2/2000, 9-day).

Please PRINT Clearly

Name (first)_____________________________(family)_____________________________________

Occupation ____________________________ Sex _______ Age _______ Date of Birth ___________

Home Address
Street/P.O. Box _____________________________________________________________________

City__________________________ State or Prov. ______ Zip or Post Code_________ Country______

Telephone ________________ Fax ________________ E-mail ________________________

Work Address
Company name______________________________________________________________________

Street/P.O. Box _____________________________________________________________________

City__________________________ State or Prov. ______ Zip or Post Code_________ Country______

Telephone ________________ Fax ________________ E-mail ___________________________


Do you plan to attend the 10-day retreat from Aug. 23rd to Sept. 3rd prior to the conference? _______
If yes, have you submitted the retreat application form? _________
Have you previously attended a 10-day course as taught by S. N. Goenka? ___________________
How did you hear about the conference? ______________________________________________

Accommodation -- due to the expected large numbers, we cannot guarantee on-site accommodation.

On-site accommodation options, please circle preference: [dormitory] [cabin] [VMC tent] [own tent]

Using off-site accommodation [yes] [no]       (click here for off-site accommodation options)

Live locally, no accommodation needed [yes] [no]

Mail or fax this registration form to V.M.C., 386 Colrain-Shelburne Rd., Shelburne, MA 01370, USA • Fax (413) 625-2170

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