Yoga Retreat Registration Form If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required For which retreat are you registering? * Where did you hear about this retreat? First Name * Last Name * Address 1 * Address 2 City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip / Post Code * Phone * Email * Emergency Contact Name * Emergency Contact Phone * Please indicate your experience or level (1-10): Yoga Experience Meditation Experience Diet restrictions / preferences / allergies (vegetarian, vegan, wheat, etc.) : Health / Medical condition we should know about: Do you snore, and if so, how loudly? Other (non-food) requests or preferences: Anything else you would like us to know? What is your joy and passion? What is your line of work? Are you willing to follow our guidelines with regards to alcohol on this trip? Are you willing to be moderate in your use of electronics during this trip? For example, we ask that no cell phones be brought to the table during mealtimes. Cool? Deposit Deposit is nonrefundable: $500 for international retreats, $500 for Sedona retreats, $100 for WA weekend retreats, $45 for one-day retreats. Note: In certain special cases we can transfer part of your deposit to a future retreat. BALANCE Balance due 30 days prior to retreat. Again, deposit is nonrefundable, but 3/4 of later payments may be refunded if you cancel > 30 days prior to trip, 1/2 refund if you cancel 15 - 30 days prior to trip (depending on retreat center refund policy), no refund under 15 days prior to trip--unless I can get some money back from hotels and retreat center. Release Form Release Form: I understand that I am solely responsible for my health and safety, and will not hold retreat leaders responsible for any loss, injuries, or illness that may occur. I will consider the interests of the group, but know that I may participate in as many or as few of the activities as I like. Please note: To insure a safe and sacred a space, we do not allow alcohol at the retreat center itself. There are often offsite opportunities for moderate, mindful drinking. Thank you for understanding and agreeing. Check this box to indicate that you agree to the release form * If you are a human and are seeing this field, please leave it blank. After clicking the submit button, you will be redirected to a page with options for making a deposit by check or online payment.
