Online Registration Beginner's Meditation Class Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone number*Email* MotivationWhat's your motivation in learning about meditation? Meditated Before?Have you meditated before? Yes No Previous Practice:Please describe when/where: Practice Regularly?Do you practice regularly? Yes No Food Allergies:Do you have any food allergies? If so, please briefly describe: Health Problems:Do you have any health-related problems? If so, please briefly describe: Heard about this event:Where did you hear about about this event?DDM-Chicago Chinese newsletter (mail)DDM-Chicago e-newsletter (email)DDM-Chicago websiteDDM-Chicago Facebook pageSearch engines (Google, Yahoo etc.)Meetup.comOther online event listingsFrom friends or family membersFlyer on public bulletin boardOtherIf you selected "Other" in the drop-down menu above please tell us where you heard about this event:If you selected "Other" in the drop-down menu above please tell us where you heard about this event: DonationThe suggested donation is $30 and you can pay online (via PayPal) below. If you prefer to pay cash (or via check) at the event please change the Payment Method and adjust the amount to $0 in the box below (to circumvent the PayPal step). Payment Method*Online with PayPalCash (or Check)Adjust the Total Amount?Would you like to adjust the suggested amount? If so, please select the "YES" button below and update the amount as you wish. If not, please select "NO" and proceed to the "SUBMIT" button at the very bottom of this page. If you are planning to bring cash (or a check) select "YES", enter $0 as custom amount (to circumvent the PayPal step), and proceed with submitting the form. You can also send in a check by making it payable to "DDMBA Chicago" and addressing it to: DDMBA Chicago c/o Iris Wang; re: "Beginner Meditation Class", 241 Holbrook Dr, Wheeling, IL 60090 YES NO Total AmountPlease enter a custom amount you would like to donate via PayPal to attend the event. Suggested amount is 30$. Class Price: Total $0.00 NOTE: After completing your online registration, please check your email for Paypal payment receipt and registration confirmation -- make sure to check your "SPAM" or "JUNK" folder as well, in case any auto-email from "ddmbachicago.org" was delivered there by mistake. CommentsThis field is for validation purposes and should be left unchanged.