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New Year Yoga Retreat, Shekina Yoga Retreat, Glastonbury, UK
Booking Form
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Indicates required field
Full Name
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Retreat Date
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29th Dec '18 - 1st Jan '19
Email
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Mobile Phone Number
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Sex
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Male
Female
Emergency Contact
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Name/Relationship of Emergency Contact
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Are you driving & willing to car share?
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Yes
No
Yoga Experience
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Complete Beginner
Have practiced a little yoga
Practice regularly
Intermediate
Yoga Teacher
What style of Yoga do you practice (if known)
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Hatha Yoga
Sivananda
Ashtanga
Iyengar
Kundalini
Other
Do you have a Meditation practice?
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Yes, regularly
Yes, occasionally
No
Do you need to borrow a yoga mat?
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Yes please
No, I have my own mat
Please let us know of any medical problems or medication
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Please include any old injuries, recent surgery, if you have heart problems, high or low blood pressure. Are you taking medication?
Are you pregnant?
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No
Yes
Do you have any food intolerance or foods that you can not eat? All meals are Vegan
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Meals on our Yoga Retreat are all vegetarian
Accommodation (Prices are per person. All accommodation is shared. Please contact us for single occupancy, triple requests)
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5 bed cabin - unisex dorm - £319
Single Private room - £399
Twin Shared Room - £369
Double/Triple shared room - £369
Double/Triple ensuite - £389
Payment Amount
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I would like to pay in full
I would like to pay 50% deposit
Payment Options (please contact us if you need to pay in installments)
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Bank Transfer -Miss C Conway, A/C 44177860 sort 30-62-96 (LLoyds Bank). Please put your name as a reference when sending payment.
Cash (in person only)
Paypal - email - info@yogaprema.org
If you would like to share a room with a friend, what is their name?
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How did you hear about the Retreat?
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Additional Information
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All information provided will remain confidential and used only for Yoga Retreat purposes. Please be advised a 50% deposit secures your place. Any remaining balance must be paid by Wed 12th Dec'18. Deposits are non-refundable. We cannot refund or transfer within 2 weeks of retreat start date or once the retreat has started. We really look forward to sharing the weekend with you!
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I understand my own body’s challenges and take full responsibility for my own practice
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Agree
If you are unsure about practicing yoga due to a medical complaint, please consult your medical practitioner or doctor
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