International Buddhism Center
Wat Phradhatu Doi Suthep Rv.
T. Suthep, A. Muang, Chiang Mai, Thailand 50200
Telephone: (66) 0 5329 5012; E-Mail: contact@fivethousandyears.org

 
 


APPLICATION FORM

Surname:   Name:
Date of Birth: Gender:
Address/Country:   Town:
E-Mail:  Phone:
   
I want to participate in:
Arriving day:
Leaving day:
Have you meditated at Doi Suthep before? Yes / When? 
  No
Do you need a translator?   Yes / Language:
  No
   
Are you currently on any medication? Yes / No   
Do you have special requirements?
   
Please type any other information here:


 
         
         
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