Name
*
First Name
Last Name
Date of birth
*
MM
DD
YYYY
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Email
*
Best Phone #
*
(###)
###
####
How did you hear about this retreat?
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(All answers are confidential.) Do you have any injuries or conditions that affect or limit your movement? Include vertigo, pregnancy, arthritis, and any other limiting conditions so that we may be prepared to help you modify during the practices.
*
(All answers are confidential.) Please tell us about your yoga and meditation practice. Are you new? How long have you been practicing? Have you had any life-changing events? What are your intentions for this retreat?
*
By submitting your registration and deposit, you are agreeing to the following Terms and Conditions for this Retreat:
*
Payment
*
I will make my payments via:
Anything else you'd like to share with us?
*
If you'd like to share a room, let us know who you'd like to room with. (Separate registration required for each individual.)
Thank you for your registration.
Your space will be confirmed via email upon receipt of both this form and the deposit.
We’re happy that you’re joining us!
~Althea and Catherine
