HOME
Join our Mailing List
CLASSES
CLASSES
Workshops
Strengthen your Core Workshop
Look after your back Workshop
RETREATS
TEACHER TRAINING
Yin Yoga Teacher Training
About us
About us
Charity
Testimonials
About Yoga
>
About Yoga
The 5 points of Yoga
The 4 Paths of Yoga
Class Chant Sheet
CONTACT
GALLERY
Blog
Class locations
0778 926 3366
New Year Yoga Retreat, Shekina Yoga Retreat, Glastonbury, UK
Booking Form
*
Indicates required field
Full Name
*
Retreat Date
*
29th Dec '18 - 1st Jan '19
Email
*
Mobile Phone Number
*
Sex
*
Male
Female
Emergency Contact
*
Name/Relationship of Emergency Contact
*
Are you driving & willing to car share?
*
Yes
No
Yoga Experience
*
Complete Beginner
Have practiced a little yoga
Practice regularly
Intermediate
Yoga Teacher
What style of Yoga do you practice (if known)
*
Hatha Yoga
Sivananda
Ashtanga
Iyengar
Kundalini
Other
Do you have a Meditation practice?
*
Yes, regularly
Yes, occasionally
No
Do you need to borrow a yoga mat?
*
Yes please
No, I have my own mat
Please let us know of any medical problems or medication
*
Please include any old injuries, recent surgery, if you have heart problems, high or low blood pressure. Are you taking medication?
Are you pregnant?
*
No
Yes
Do you have any food intolerance or foods that you can not eat? All meals are Vegan
*
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)
*
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
*
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)
*
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?
*
How did you hear about the Retreat?
*
Additional Information
*
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!
*
I understand my own body’s challenges and take full responsibility for my own practice
*
Agree
If you are unsure about practicing yoga due to a medical complaint, please consult your medical practitioner or doctor
Form Completed by (Name)
*
First
Last
Submit
Web Toolbar by Wibiya
