Yoga Retreat 2018 Form * = required field Your Name* Date of Birth* Format YYYY-MM-DD format (e.g. 2013-04-08) Your Full Address* Your Telephone* Your Email* Health Please take the time to accurately describe the following, if applicable Allergies Injuries Medical conditions Medication: Dietary Requirements Please check here to confirm you have entered your health information accurately. Room Option Double Bed, Shared RoomDouble Room, PrivateSingle Bed, Shared Room Please give a short description about your current yoga experience, and reasons for choosing this retreat Please let us know any more information you feel is relevant to the time you will spend with us on retreat