Booking form - Yoga Retreat Sept 2012

Address *

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City

State

Zip Code

Country

Mobile Phone Number *

Emergency Contact *

Name/Relationship of Emergency Contact *

Are you driving & willing to car share? *

Yes No

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 *

Are you pregnant? *

No Yes

Do you have any food intolerance or foods that you can not eat? *

Accommodation *

Camping - Early Bird Price before 31st May - £180 Shared room - Early Bird Price before 31st May - £210 Single room - Early Bird price before 31st May - £269 Camping - Full Price from 1st April - £195 Shared room - Full Price from 1st April - £235 Single room - Full Price from 1st April - £299

Payment Options *

Bank Transfer - Account Number 44177860, Sort 30-62-96, Miss C Conway, LLoydsTSB Cheque - payable to C Conway, postal address - Yogaprema, c/o Unit 19, The Coach House, 2 Upper York Street, Bristol BS2 8QN Cash (in person only)

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 27th July, 2012. Cancellations within 6 weeks of retreat start date - deposits are non refundable, unless we can fill your place with another person. 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

Form Completed by (Name) *

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Yoga Retreat, Braziers Park, Oxfordshire, Fri 7th - Sun 9th Sept 2012Booking Form

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Yoga Retreat, Braziers Park, Oxfordshire, Fri 7th - Sun 9th Sept 2012
Booking Form