I, _____________________________ , the undersigned, hereby declare that all the information given above is true and I have not left out any important items, and undertake to abide strictly by the rules of Panditarama*, practice dilligently and follow closely the instructions of the meditation teacher. I also understand that Panditarama will not be responsible in the event of any physical, mental or psychological injury incurred during my stay in Panditarama.

Date:___________                                       Signed __________________

 * The rules include the observance of the Eight Precepts, such as abstention from food after mid-day, alcohol, drugs and smoking.

 Please note that the Retreat is conducted in English language.