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 Marambi 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 people to a dorm.) To help us with room assignments we are asking you to tell us 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.


April 14 - 19, 2014

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

For more information, please contact Ginni Stern: email, or by Phone: 802-734-6223 or by 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 to and at the Murambi Memorial Site as will as accommodations in Kigali on the evening of April 14. Travel to Kigali and your stay in Rwanda before and/or after is not included in the fee.

Final Registration in Kigali

Final registration will take place in Kigali, in the


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?  

Please include your birthdate.  


How many times have you attended an Auschwitz Bearing Witness Retreat? (0-16)  

How many times have you attended a Rwandan Retreat with Fleet Maull and Grover Genro Gauntt? (0-2)  




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 French     Fluency in Kinyarwanda    

Fluency in German     Fluency in Flemish     Fluency in Spanish    

Fluency in Italian     Fluency in Arabic     Fluency in Hebrew    

Fluency in Dutch    

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  

Religion you were born into:  

What is your spiritual practice now?:  

Was your family directly impacted by the Tutsi Genocide?  

Was your family directly impacted by any other Genocide?  

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

Comments (Special Needs, Medical conditions you'd like us to know about, etc.))

Emergency Information

In case of emergency whom should we contact?

Emergency Contact Name:  

Primary Language of Contact       Contact's Fluency in English  

Relation to you:   Country they live in:  

Emergency Contact Phone #'s:
Mobile  Home  Office  

Emergency Contact Email address: