Stanthorpe Yoga Retreat 2013
Stanthorpe Yoga Retreat Registration Form 2013
For the safety and maximum benefit of yourself and others on the retreat, please answer the following questions briefly but honestly. All information will be treated confidentially.
Name:
Age:
Occupation:
Telephone home contact number:
Mobile number:
Email address:
Emergency home contact details (next of kin):
Previous yoga experience: (e.g. no. of years, styles, teachers etc.)
Medical conditions/surgery/injury in the last year:
Are you currently on any medication, or taking or withdrawing from any kind of meds/drugs?
Do you have any history of mental illness?
What would you most like to get out of the workshop?
Dietary Needs
Do you have any specific dietary needs? All food prepared will be vegetarian, however gluten free/lactose free/vegan can be catered for, if we have prior notice.
Massage
Massage will again be offered as an optional extra at the retreat. As there are limited spaces please indicate if you would like to book a massage over the weekend. It is anticipated that each massage will be allocated 45 minutes, and the cost will be in line with current local rates (TBA).
I would like to book a massage at the retreat (circle one) YES NO
Payment details:
Full Price $350
Early Bird $325
Includes two nights accommodation (dormitory style), all meals (vegetarian), including morning and afternoon teas, yoga and meditation classes and workshops. Massage is an optional extra.
Once a deposit of $200 is taken, your place is secured. Early bird price of $325 if paid in full prior to September 30 2013 applies. Otherwise remaining dues to be paid in full by October 31, 2013.
Direct electronic transfer details:
Maree Taylor
YogaHeart
Commonwealth Bank Stanthorpe
BSB: 06 4431
A/C No: 1019 0784
Use your name as reference.
You can pay in cash, by cheque or money order if you prefer. Please make cheques out to Maree Taylor.
Many Thanks
Maree & Tricia
Please email this form back to:
Maree and
Tricia
1