Annual North American Mahamudra SeminarMay 22nd - June 2nd, 2010 at Ser Cho Osel Ling near Goldendale, WA

Registration FormPresented by Lama Michael Conklin and Lama Tara

Name. Today's DateAddress --------------------------------------------City State __ Zip Phone (,-_-»

Email

Car Pooling: I need a ride: Yes NoI can give a ride: Yes No I can take ----'passengers and their luggageI would like to help with the following: Tending shrine Teacher's waterBookstore Sound system _Accommodations: Do you need special accommodations with lodging or in the shrine room for a physical condition,please describe.

Emergency Contact:List any dietary restrictions:Male Female Age _

Phone~

This is the __ (1st, 2nd, etc.) time I've attended a retreat in Bokar Rinpoche' s ProgramI have taken Refuge Yes NoI will be receiving the following Ngondro instructions for the first time:RefugelProstrations Vajrasattva Mandala Guru Yoga

Price: $615 for cabins or dorm style. $505 for camping (US Funds), which includes lodging, meals, snacks, and asmall stipend for Lama Tara. As a gesture of respect, a discounted price of$265/$155 is available to ordainedsangha and those who have completed 3-year retreat.

A deposit of $300 will reserve your spot. The balance must be received by May 9th

With your generosity we can expand our sharing of the dharma with those who otherwise would be unable toparticipate. Please consider contributing to the Scholarship Fund. To request a scholarship (up to 50% of retreatcost), please include a brief statement of financial need and practice history along with your completed registrationform and full deposit ($300).

Retreat Cost (choose one)Donation to Scholarship FundTotal Cost $Amt. Enclosed $

$ 615 or $505 US Charge my VISA 1MC (circle one) $ _$ Charge Card Payments for FULL AMOUNT ONLY

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Balance Due by May 9th $ Signature -'Exp. 1

ALL PAYMENTS MUST BE IN US FUNDS.

Make checks payable to "KCC"Send your completed form and payment to

Sherry Bohannan, KCC, 73 NE Monroe St., Portland, OR 97212

Please note: KCC would like to occasionally send you notices of upcoming events and other informationabout KCC activities. We do not share your personal information with other organizations.

o I would NOT like to receive mailings.

2009 Annual North AmericanMahamudra Seminar

Cancellation and Refund Policy

The cancellation policy is in place so that KCC can cover the fmancial costs of hosting aretreat. Should you be unable to attend, you will be expected to pay a cancellation fee.

KCC is also committed to providing an opportunity for as many people as possible to attendretreat, which is why it's so important to let the Registrar know as soon as possible if you decidenot to attend.

If you discover that you are unable to attend this retreat, please immediately contactSherry Bohannan (Registrar), at

sherrybohannan@comcast.net

503-381-5669

If notified soon enough, your space can be offered to another person.

Cancellation Date Amount Refunded based on lodging

Prior to April 25th $605 or $495

April 25 - May 9th $495 or $300

After May 9th any amount paid above the deposit is refunded in :full if you donot attend the retreat.

Registration Deadline Date: May 9, 2009 (balance must be paid in full)