Supporting the Vision and Inspiration for Socially Engaged Buddhism Throughout the World
Please fill out one Registration Form for each person attending the retreat.
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 10 - November 14, 2014
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: firstname.lastname@example.org, or by
Phone: 802-734-6223, USA mobile until October 23, 2013 & after December 12, 2013
German Mobile activated in Poland: 0049-1587-755-5290, only November 1 thru December 9, 2013,
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@example.com
Final Registration in Krakow
Final registration will take place in Krakow, in the Saski Hotel Lobby, Sunday night, November 9, 2014. 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
Prince Edward Island
District of Columbia
Antigua and Barbuda
British Indian Ocean Territory
Central African Republic
Cocos (Keeling) Islands
France (European Territory)
French Southern Territories
Heard and McDonald Islands
Ivory Coast (Cote D'Ivoire)
New Caledonia (French)
Northern Mariana Islands
Papua New Guinea
S. Georgia & S. Sandwich Isls.
Saint Kitts & Nevis Anguilla
Saint Pierre and Miquelon
Saint Tome (Sao Tome) and Principe
Saint Vincent & Grenadines
Svalbard and Jan Mayen Islands
Trinidad and Tobago
Turks and Caicos Islands
United Arab Emirates
USA Minor Outlying Islands
Vatican City State
Virgin Islands (British)
Virgin Islands (USA)
Wallis and Futuna Islands
Home Telephone Office Telephone Cellular Telephone
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.
Young Adults (ages 18-28)
Member of Young Adult Group
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?
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)
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.
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:
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:
P.O. Box 460 | Sunderland, MA 01375 | Phone: (413) 367-5278 | Webmaster