Ten-day Vipassana Meditation Course

Jan 7th - Jan 17th , 2028 at 54 Cessnock Rd, Sunshine NSW 2264 with Dr Mark Peterson

Please note: Entries marked with an asterix (*) are required fields for completion of the e-application. If there are problems submitting the form, please contact the centre by phone or email to apply for a course.

Student Details

First Name* Surname* Date of Birth* Gender Occupation* Nationality* Do you understand English well?* If no, which language?

Contact Details

Email Address* Phone Number* Mobile Number Address* Suburb* State* Postcode* Country*

Emergency Contact Details

Full Name* Phone Number* Address*

Meditation Experience

Have you attended courses in the Sayagyi U Ba Khin Tradition before?* If yes, please say when and where was your most recent course Are you practising any other techniques of meditation?* If yes, for how long have you been practising them

Medical Details

Are you in good physical and mental health?* If no, please give details Are you, or will you be, on any medical treatment at the time of the meditation course?* If yes, please give details of medication Do you suffer from any medically confirmed food allergies?* If yes, please give details Please note: only medically confirmed allergies will be recorded.

Course Enrolment

How did you come to know about this centre and meditation course?*