Personal Information Form

Hint! To print this form: Select (highlight) the text  below, including the address and form and print the SELECTION. We ask that everyone at Great Tree complete this form for each event they attend.   Send it by snail mail to:


This form is required for all attending a sesshin or retreat and must be submitted each time. 

Great Tree Zen Temple   679 Lower Flat Creek Rd     Alexander, NC 28701

Arrival Schedule: Most events begin with a light meal on the first evening  and end at noon on the last day. Please arrive to check in by 4pm; orientation and preparation begins at 5pm. Call if you need directions: 828-645-2085 Fees: If you are sending a deposit only, please include  your check or money order for 1/2 the event fee (for events over $100.)  Make checks payable to Great Tree Zen Temple and mail it to the address above. Please indicate the event on the memo line.  This secures your reservation. Registration closes when the events fills or 3 days prior to the event: forms and payment in full must be complete 7 days prior.  We do not have credit card processing on site.  Please indicate the event on the memo line of your check.
Cancellation Policy: If you need to cancel, we request that you do so in a timely fashion, so we can contact people on the waiting list. We must receive your cancellation no later than 7 (seven) days prior to the event. There is a $25. cancellation fee for events after 7 days. If Great Tree cancels  (this is rare), the entire amount will be reimbursed. If you have prepaid in full,
Thank You!
Membership: Please visit the Membership page of Great Tree’s website. If you have been on our mailing list for over 90 days, you are a member. You may,  if you wish opt to apply member fees for sesshins and some retreats.

Select the lines below; set your printer to “Print-Selection”. Or you can copy and paste them to your word processor.

Name(s):______________________________________________________________________

Address: _________________________________________________________________________

City:_________________________________________State_________Zip____________________

Phone (s): ______________________Email:__________________________

Program:_____________________________________________________

Membership?   Yes/ No/Sign me up      Amt.____________ Check/MO/PayPal

Arrival:Date/Time:______________   Departure:_____________________

Special Diets:__________________________________________________

Prescriptions or special needs?______________________________________________________

___________________________________________________________

Emergency contact(s): _____________________________________________

Phone(s): _______________________________________________________

Insurance Information:____________________________________________________________

Name and contact for primary physician:________________________________________________________

Date:______________

 Signature:_______________________________________________

Any other comments or concerns?