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Aryaloka Buddhist Center

Registration Form

Please make your reservation at least one week in advance.

Please print out this form, fill it out, and mail it to us at the address above. You may also register by phone by calling us at (603) 659-5456.

Registrant information
Name: ______________________________________________________________
Address: ______________________________________________________________
City: ______________________________________________________________
State: ______________________________________________________________
Zip Code: ______________________________________________________________
Phone (days): ______________________________________________________________
Phone (evenings): ______________________________________________________________
Email: ______________________________________________________________

Event information
Event name: ______________________________________________________________
Date: ______________________________________________________________
Event fee*: ______________________________________________________________

*A reduced fee is available if you are a student, retired, or otherwise unable to pay the full amount. Call us at (603) 659-5456 or email us at info@aryaloka.org for more details.

Payment information
A non-refundable, non-transferable deposit is requested: $15 for day events, $30 for weekend retreats, $50 for longer retreats, with any remaining balance due upon arrival. (Note: Yoga and Meditation Retreat requires payment in full at time of registration.)
I will mail a check payable to FWBO and mail it to

Aryaloka
14 Heartwood Circle
Newmarket NH 03857
Please charge my credit card
Type: (MC or Visa only) ______________________________________________________________
Card Number: ______________________________________________________________
Expiration: ______________________________________________________________
Charge amount: ______________________________________________________________
Signature: ______________________________________________________________


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