This Online Retreat Application Form is suspended from use because of technical glitches.

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General Guide:

  • Fields marked with * are compulsory. 
  • Information submited is retrievable for future retreat application.
  • Dana form can be downloaded and submitted separately later by emailling it to or contact us.
  • Please submit retreat application form only once.
  • For further enquiries, use the website contact us form.

  • Retreat Rules & Regulations - please do take some time reflecting on these rules and regulations. Your agreement to abide by the terms is a practice in mutual concern and care for each other's harmonious progress during the retreat.
  • Retreat Dana Form - please download and do consider appropriately your generous intention of sowing seeds of bountiful & sweet fruits in an appropriate fertile soil. We plan to inform benefactors of donor deeds or dedications and sharing of merits will be made before each meal during retreat, if possible.

Do you agree to abide by the Retreat Rules & Regulations for the retreat?*
Check the retreat(s) you intend to attend.*

1. Personal Info

First Name:*
Last Name:*
E-mail Address:*
What is your age?*
What is your gender?*

What is your occupation?*

2. Contact Info

Address Line 1*
Address Line 2
Postal Code*
Home Phone*
Mobile Phone*
In case of emergency, who do we contact?*
How are you related?*
Provide emergency contact telephone number.*

3. Practice History

Please state the meditation method practised.*
How long have you used the method?*
Who is your current meditation teacher?*
Please state any physical or psychological health matters that the meditation teacher needs to know in order to assist you best.*

4. Dana Practice

Please check the area(s) of interest you are able to offer to assist in the propagation of the Buddha-Dhamma.

Other areas, please state.
Retreat Dana Form (Browse to submit)

5. Other Matters

Please specify any special assistance that you may need e.g. direction, transport, accommodation, etc before & after retreat (especially for non-Penangites and overseas participants). Any other message for the retreat organisers.

Form will be submitted to :
Sayalay Susila Retreat Organising Committee
Appamada Vihari Meditation Center, Penang.

To prevent spam, please tell us:
What is seven plus nine?*
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