Application for the Australian Retreat with His Eminence Dzogchen Rinpoche (Teaching Online via Zoom)

Thank you for taking an interest in the teachings of His Eminence the 7th Dzogchen Rinpoche, Jigme Losel Wangpo. Dzogchen Rinpoche is the holder of the 400-year-old lineage of Dzogchen and due to the precious nature of these teachings, it is important for Rinpoche to have a clear view of your spiritual history.

Please complete all sections of this application form before submitting.

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Please select the event you would like to attend (only select one)

Thursday 12th November (arrival day) to Sunday 22nd November 2026

Attandance via zoom

AU$ 950

contact: dzogchenretreat@shenpenaustralia.org

Drupa Na Sel: Friday 6th November (arrival day) to Friday 13th November 2026

Retreat: Thursday 12th November (arrival day) to Sunday 22nd November 2026

Attandance via zoom

AU$ 1190

contact: dzogchenretreat@shenpenaustralia.org

Personal Details

First Name:
Last Name:
Occupation:
Date of Birth:
/ /
Age:
Gender:
Male Female Other Prefer not to say
Address:
Town / Suburb:
County / State:
Postcode / Zip:
Country:
Phone:
Email:

First Retreat / Seminar

Is this your first Retreat / Seminar with H.E. Dzogchen Rinpoche? No Yes

Photo

If this is your first Retreat / Seminar with H.E. Dzogchen Rinpoche, you will need to upload a photo.
Please upload a standard passport photo of yourself.
The file must be one of the following formats - jpg, jpeg, gif or png.
The file must not be larger than 250kbs.

Emergency Contact

Name:
Relationship:
Phone:

Spiritual Details

Do you follow any spiritual tradition or lineage?

Tradition:
Since (Year):
Do you have a main teacher? If so, who?

Are you doing any spiritual practices?

Have you already connected to H.E. Dzogchen Rinpoche? How did you make the connection?

How did you hear about this retreat / seminar and why would you like to attend?

Other Details

To ensure we can provide a comfortable, safe, and peaceful experience for everyone, please let us know if you have any medical conditions, disabilities, or accessibility needs that may require accommodation. All health information is kept strictly confidential.

Making your payment

Electronic Funds Transfers (EFT) can be made out to the following bank account:

  • Name: Shenpen Inc
  • BSB: 035-034
  • Account no: 212976
  • Swift code: WPACAU2S

Please ensure that your name and the words 'National Australian Retreat 2026’ appear in the transaction details

Once your payment has been made, please send a proof of payment to dzogchenretreat@shenpenaustralia.org

Cancellation Policy

  • A AU$ 100 administration fee will be charged for cancellations made at least seven (7) days prior to the start of the event. Cancellations made after this time will receive a 50% refund only.
  • Should your application not be successful a full refund will be given.
  • While we understand that unforeseen circumstances can happen, please be aware that withdrawing a successful application can be disrespectful to the Lineage and might also affect future applications.

Declaration

All information given by you on this application form is regarded as strictly private and confidential within Dzogchen Orgyen Samten Chöling and will not be distributed to any other persons or organisations. Dzogchen Orgyen Samten Chöling (Shenpen Australia and Shenpen International) cannot accept responsibility for personal accidents, injuries, illnesses, exacerbation of existing medical conditions or loss/damage to your personal property during these events.

Please tick the box if you would like to be on the Dzogchen Orgyen Samten Chöling mailing list. (OPTIONAL)

I have understood the above and confirm that all information provided on this form is true and correct.

I confirm that I have made the payment for the event.

Error: Events - you must select one event, and one event only.

Error: Missing details - please complete all sections of the form.

Error: Photo - no image has been selected.

Error: Photo - the format of the image you have selected is not supported.

Error: Photo - the size of the image you have selected is too large.

Error: Photo - the dimension of the image you have selected is too small.

Error: Declaration - the declaration must be accepted (ticked).

Error: Payment - payment must be confirmed (ticked).

Error: ReCaptcha - you must select the ReCaptcha.