RETREAT REGISTRATION FORM

Please note that all information gathered is strictly confidential, and will be shared only with Intouch Yoga teaching staff as needed.

Dear students, for the safety and maximum benefit of yourself and others on the retreat, please answer the following questions briefly but honestly. Many thanks.

Name*
First Last
Your Age*
Mobile Phone Number*
Home Phone Number*
Email*
Enter Email Confirm Email
What is the date of the Retreat you want to attend?*
What accommodation type would you like?*
- Canopy Cabin Single -$2,530.00
- Canopy Cabin Twin Share pp-$2,120.00
- Rainforest Hut with Alfrescoe Ensuite Single-$2,120.00
- Rainforest Hut with Alfrescoe Ensuite Twin Share pp-$1,900.00.00
Your Occupation
Previous Yoga Experience*
List Medical Conditions and Recent Surgery*
Are you currently on any medication, or taking or withdrawing from any kind of meds/drugs?*
Do you have any history of mental illness?*
List any dietary requirements or allergies*
What would you most like to get out of your retreat?*
Emergency Contact Number*
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- Yes, join me up!
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RETREAT REGISTRATION FORM

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