Booking form - Braziers Sept 19

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Yoga Retreat, Braziers Park, Oxfordshire, UK - 6th - 8th September 2019

* Indicates required field

Full Name *

Address *

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City

State

Zip Code

Country

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, medication or special needs *

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? *

Meals on our Yoga Retreat are all vegetarian

Accommodation *

Shared Room Single Room

Payment Amount *

I would like to pay in full I would like to pay £100 deposit I would like to pay another amount (please use the comments box below to give more info)

Payment Options (please contact us if you need to pay in installments) *

Bank Transfer - Account Number 44177860, Sort 30-62-96, Miss C Conway, LLoyds Bank

If you would like to share a room with a friend, what is their name? *

How did you hear about the Retreat? *

Anything else you would like to tell us about? *

All information provided will remain confidential and used only for Yoga Retreat purposes.Places are not confirmed until the retreat deposit has been received. Full payment is required 4 weeks before the retreat start date. If payments are not received in full, 4 weeks before the retreat starts your place may be offered to another person. Please contact us if you need more time to pay the balance and may be able to extend the payment date. No refunds, credits or transfers will be given 4 weeks before, during or after the retreat has started. It may be possible to pay in installments, please contact us. 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

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