Supporting the Vision and Inspiration for Socially Engaged Buddhism Throughout the World

Please fill out one Registration Form for each person attending the retreat.

Please fill out the form below and push the submit button (at the bottom of the form), the return key,
or the enter key to send it to us. The tab key will take you from field to field.

Some rooms at Auschwitz are doubles. Priority is given to couples for the doubles. If you are attending the retreat as a couple, please list your roommate below and select "yes" on the couple's button. There are also triples and dorms (6-8 people to a dorm.) To assist us with making room assignments we ask your gender. If you have a desired roommate, please give us their name in the appropriate box . If you have special needs please list them in the comments box.


November 9 - November 13, 2015

Please fill out the form below. When you click on the "Submit Button" you will be forwarded back to the Auschwitz Retreat page.

For more information, please contact Ginni Stern: [email protected], or by Phone: 802-734-6223, Skype: ginnistern.

Housing is generally in dorm rooms. There are a few doubles and triples. Priority is given to couples for the doubles. If you are attending the retreat as a couple, please list your roommate below and select "yes" on the couple's button.

The fee includes all buses, food and accommodations at the Dialogue Center in Oświęcim (walking distance to both Auschwitz 1 and Birkenau). Plane fare and your stay in Krakow are not included in this registration fee. Upon on-line registration, you will receive a post-reg letter filled with information to assist you in preparing for the retreat. If you have any questions before registering contact [email protected]

Final Registration in Krakow

Final registration will take place in Krakow, in the Saski Hotel Lobby, Sunday night, November 8, 2013. At that time, you will receive your registration packets, including retreat schedule, your room assignment at the Center for Dialogue, list of names to read at Auschwitz site, name tags and other general information.

We are reserving a block of rooms at a group discount rate at the Saski Hotel. We recommend that you make your reservations at this hotel (please click on the "Hotel" Tab for directions on how to secure a reservation with the Peacemaker group discount.) The Krakow hotel cost is not included in the Retreat Fee. You can see other lodging options by clicking on the "Hotel" Tab.


First Name      Last Name  

Name you like to be called  



Address  

Address2  

City    State   or Province  

Country   Zip Code  


Home Telephone            Office Telephone                               Cellular Telephone
   

E-Mail Address

How did you hear about this retreat?  

If you were referred to this retreat by a previous participant, please write the person's name here.

Your birthdate.  


Young Adults (ages 18-28)

Member of Young Adult Group          Country Representing  


How many times have you attended an Auschwitz Bearing Witness Retreat? (0-18)  

English is the primary language used during the Auschwitz Retreat. In order to assist staff in making small Council Groups as diverse as possible, please indicate your language abilities. Also, if you are willing/able to assist others with translations in which language?

Primary Language  

Fluency in English  

In order to assist those attending with varying fluency in English, please choose the languages below that you are willing to assist others with translations. Thank you in assisting us in helping others.

Fluency in German     Fluency in Polish     Fluency in Spanish    

Fluency in Italian     Fluency in Arabic     Fluency in Hebrew    

Fluency in Dutch     Fluency in Flemish     Fluency in French    

Fluency in (Input other language you have fluency in)  

Participant's Gender  



There are some doubles rooms. Priority is given to couples for the doubles. If you are attending the retreat as a couple, please list your roommate below and select "yes" on the couple's button.

Desired Roommate's Name


We are a couple  


If you leave the Desired Roomate blank, you will be assigned roommates of your own gender.

Vegetarian  

Other medical dietary requirements:



Religion you were born into:  

What is your spiritual practice now?:  

Was your family directly impacted by the Holocaust?  

What draws you to the Auschwitz Retreat at this time in your life?  

We will have a limited number of meditation cushions (zafus), please indicate here if you desire a cushion or prefer sitting on a bench during our meditation periods.   

Other comments, special needs or medical conditions you'd like retreat staff to know about:

Emergency Information

In case of emergency whom should we contact? Please note someone NOT at the retreat with you.

Emergency Contact Name:  

Primary Language of Contact       Contact's Fluency in English  

Relation to you:   Country Emergency Contact lives in:  

Emergency Contact Phone #'s:
Mobile  Home  Office  

Emergency Contact Email address: