your retreat booking form

Choose your retreat *

Your name *

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Last

Address *

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City

State

Zip Code

Country

Email *

Mobile Phone Number *

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Home Phone Number *

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Date of Birth *

Sex *

Male Female

Emergency Contact *

Name/Relationship of Emergency Contact *

Are you driving & willing to car share? *

Yes No

What style of Yoga do you practice (if known) *

Do you have a Meditation practice? *

Yes, regularly Yes, occasionally No

Do you need to borrow a yoga mat? *

Yes please No, I have my own mat

The reason you coming to this retreat *

Do you have a health insurance? *

Yes No

Do you wish to get a health insurance here when you'll arrive? *

Yes No

Please let us know of any medical problems or medication *

Are you pregnant? *

No Yes

Do you have any food intolerance or foods that you can not eat? *

Payment Options *

Bank Transfer Cash (in person only)

Share Rooms Only, if you don't know anyone we'll put you together with the same gender people in a room, if you know please wright a friends name. *

How did you hear about the Retreat? *

Additional Information *

All information provided will remain confidential & used only for Retreat purposes.

I understand my own body’s challenges and take full responsibility for my own Yoga or Skiing, Snowboarding, Canyoning, Swiming, Climbing, Cycling, Hiking practice *

I agree

Form Completed by (Name) *

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