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