Please fill in this form PERSONAL INFORMATION MaleFemale Which Venue do you want to go? UKAustiaGreeceOther PLEASE PROVIDE EMERGENCY CONTACT DETAILS MEDICAL QUESTIONNAIRE Are you currently on any medication? If so, please state NoYes Do you have any issues like; Anxiety, Panic attacks, Depression, PTSD, BPD? NoYes Are you currently taking any alcohol or drugs? If so, please state NoYes I hereby certify that the above information is correct and true to the best of my knowledge. I accept that Martin Pack and/or any personnel in charge shall not be held responsible for any incident arising during my stay. In addition, I shall strictly observe the Meditation Centre’s rules and regulations as well as meditation instruction given by any meditation teacher and/or related personnel in charge. I agree that my submitted data is being collected and stored (and handled with care).
