This is to confirm that I have transferred ______ pounds to the DharmaMind account as a deposit for the _______ retreat.

My phone number is _____________________ and I do/do not (edit as appropriate) contribute to Sangha Support.

My emergency contact person is my brother/sister/father/mother (edit as appropriate) and their phone number is ___________________ and their name  is ____________.

I do/do not have special dietary requirements, and they are ___________________________.