Chamma LingP. O. Box 608Crestone CO 81131

Chamma Ling Cabin Request Form

Applicant: Ryan Burton_____________________________________________Address: 11120 Monogram Ave Granada Hills, CA 91344______________________________________________Email:thairyan1@gmail.com_____________________________Phone:8182948433______________________________________________Application date:12/15/2013_____________

Enter your preferred and alternate retreat dates below. Your alternate dates may be assigned if the preferred dates are already filled. Please note the retreat time blocks start at Sunday at noon and end on Saturday at noon.Preferred retreat start date: Jan 5th____________Alternate start date: Jan 15th _____Preferred retreat end date: Feb 5th____________Alternate end date: Feb 8th_______

Please describe your retreat plan, including a typical daily practice schedule. Be sure include an hour of caretaking of the retreat center:

I plan to do a dark retreat for 2-4 weeks. During this retreat I will be focusing mostly on Tregchod and a bit of Samatha practice. I will be engaging in 90% Tregchod and Dzogchen practice and about 10% Samatha practice. My typical daily practice at home consists of 1-2 hours of Tregchod while sitting, 2-4 hours of Samatha meditation, 40 minutes of Taoist standing meditation, and 1 hr of Spirit-Repair healing.

From whom have your received instruction for these practices?

I received Dzogchen teachings and lungs for various practices from Chogyal Namkhai Norbu. I am a sustaining member of ChNNs Dzogchen community. I received the instructions on my Samatha practice from Phra Phadet Dattajeevo the Vice Abbot of Wat Phra Dhammakaya and continue to train under Vasin Sornprasitti in Los Angeles, CA. I received the instructions for Taoist standing meditation from Master Bruce Sun of the Wudang Southern Style Nei-Gong tradition during. I received the healing instructions for Spirit-Repair from Master John Douglas.

What level of support do you need for your retreat? Please check the appropriate box.

Level 1: The Independent PractitionerIn this type of retreat, practitioners have open access to the cabins and Chamma Ling land. Retreatants carry in their own supplies and prepare their own meals. Retreatants must be able to carry water, propane and waste to/from our central service area.

Level 2: The Closed RetreatClosed retreats require that the practitioner create a boundary around the retreat cabin, and that the practitioner stay within that boundary for the duration of the retreat. The Chamma Ling caretaker will deliver supplies to the practitioner twice a week, if contracted. Costs for supplies and caretaker services are in addition to the cabin rental and will vary according to your needs. The practitioner prepares his or her own meals.

X Level 3: The Dark RetreatIn a Dark Retreat, the practitioner is sealed inside the cabin for the duration of the retreat. Chamma Ling will provide an attendant to bring food cooked according to the needs of the practitioner as arranged. Dietary needs are to be described in writing at least two weeks before the retreat begins. Supplies delivered as in Level 2. Costs for food and other supplies are in addition to the cabin rental and will vary according to your needs. A senior practitioner will be available for practice questions.

Please describe caretaker services in detail you anticipate during your retreat, including food/supply runs, dark retreat meals, special needs. Note anything else that we should know about your retreat. The caretaker contract for extra services should be planned before your check-in date.

I am trying to save as much money as possible during this retreat. It would be ideal to spend $5/day on meal preparation. On a daily basis I only eat one or two meals and have completed fasts for 14 day periods. During the dark retreat I will only need one medium-large sized meal per day. I can have nuts, dried fruit, and vegetable drinks stored in the cabin in case my appetite for some reason exceeds my expectations.

Your Health InformationPhysician: Dr. Colby_________________________________Physician phone number: 8187192000_____________________Emergency contact information: Name: Dana Burton______________________________Relationship: Sister_________________________Phone number : 8185054312_______________________Alternate number: 8182717186_____________________Health Insurance Carrier and Policy number: Kaiser Permanente 0014414611________________________________

Please describe any health conditions that we should be aware of, including significant medical history, psychiatric history, allergies, and medications taken, including complementary medicine and treatments. Note notification and health treatment preferences in case of emergency:

N/A

Your practice BiographyTenzin Rinpoche personally reviews each retreat application and may make practice recommendations. He asks that you write a one page practice biography that describes your meditation practices up to this point in your life, and how those motivate you to undertake a retreat now. You may type this on a separate page, or write below.

In Feb 2011 I completed my first 10-day Vipassana meditation course. I began taking meditation seriously about one year after my first retreat when I signed up for a 90-day meditation course in Thailand with Wat Phra Dhammakaya, which began on Jan 2012 and ended in April 2012. In June 2012 I received the Dzogchen transmission from Chogyal Namkhai Norbu in Pasadena, CA. I returned to Thailand in August 2012. After the passing of my grand-aunt I left Thailand and completed 20-days of silent practice at Panditarama in Rangoon, Myanmar. I planned on staying in Myanmar for 8 months to engage in the Samatha practice in the lineage of Pa-Auk Sayadaw, but had to return home from Myanmar in Sept 2012 for my fathers funeral. His death was unexpected and initiated a new phase in my spiritual path. One month after my fathers passing I ordained for a short period during the Kathina Ceremony at Wat Phra Dhammakaya Azusa Branch to dedicate the merits of ordination to my father. After my fathers passing I began to develop the capacity to balance meditation and worldly life. Since then I have stuck with Dzogchen and Samatha practice. This past summer I applied to do a long term dark retreat at Tsegyalgar in Conway, Massachusetts. My uncle fell terribly ill with Guillian-Barre syndrome the week before my flight. I spent the summer meditating, praying, and sleeping in his room at Henry Mayo Hospital in Valencia, CA. I am fascinated by occult and spiritual literature from both the East and West. I began using the Spirit-Repair technology to enhance my practice after Master John Douglas healed my friend Peach of Lyme disease, Lupus, and heavy metal poisoning. I sustain a daily practice of 2-6 hours of meditation. I meditate and train weekly with my Buddhist and Taoist masters. It is my goal to be a master of the Sutra, Tantra and Dzogchen. I have dedicated my life to meditation and will teach people the path to liberation up until my final days on this earth. I am 21 years old. I live in Los Angeles with my mother, aunt, and grandmother. I have studied, and meditated diligently since my last period of serious retreat time. I am ready for a dark retreat. I am ready to take my practice to the next level. Thank you. Release of Liability

WHEREAS I am about to take part in a retreat on the property of Chamma Ling, P.O. Box 608, Crestone, Colorado at the dates named above, and whereas I am doing so entirely upon my own initiative, risk and responsibility. Therefore in consideration of permission extended to me by Chamma Ling, through its officers and agents, to take part in this program I do hereby, for myself, my heirs, personal representatives and assigns, remise, release and forever discharge Chamma Ling and all of its officers, agents and employees, acting officially or otherwise, from any and all claims, demands, actions or causes of action on account of any injury to me or my property or my death, which may occur from any cause during said program or in connection with any activities incidental thereto, and I further do hereby, for myself, my heirs, personal representatives and assigns, remise, release, forever discharge and agree to hold harmless and to indemnify and defend Chamma Ling and all of its officers, agents and employees, acting officially or otherwise, against any action or demand by any of my children, invitees or guests, or by any other person or persons for damages on behalf of such children and to further hold harmless, and indemnify and defend from any and all claims alleged to or caused or resulting from my participation, my acts or omissions, and/or such alleged to or caused by my children, invitees or guests. I further authorize Chamma Ling, its officers, agents and employees to arrange emergency medical care for me should it become necessary to do so in the event of personal injury to me. I agree to be fully responsible for the costs of any such treatment.

______________ Applicant SignatureDate 12/15/2013

Attach a check for the appropriate amount, including a $50 security deposit, or an appropriate number of your Chamma Ling Cabin coupons. See our web site for the current cabin rates (www.chammaling.org). Please note that caretaker fees are additional and paid directly to the caretaker at time of arrival. Mail this form to Chamma Ling, P.O. Box 608, Crestone, CO 81131. The Board will meet to consider your request and reply within four to six weeks.

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