Retreat Registration Page *Which Retreat Are You Registering For? *Which Retreat Are You Registering For?December 2019Jan. - Feb. 2020April 2020 How did you find out about the retreat? *First Name *Last Name *Email Address *Phone Number *Address *City *State *Zip Code *Emergency Contact Name *Emergency Contact Phone Yoga Experience (1-5) Yoga Experience (1-5)5 - Very Experienced (daily)4 - Regular Practice (weekly)3 - Ocaccional Practice (monthly)2 - Less Frequent Practice (few times a year)1 - Infrequent, No Practice, Or First Time Mediation Experience (1-5) Mediation Experience (1-5)5 - Very Experienced (daily)4 - Regular Practice (weekly)3 - Ocaccional Practice (monthly)2 - Less Frequent Practice (few times a year)1 - Infrequent, No Practice, Or First Time Diet restrictions / preferences / allergies (vegetarian, vegan, wheat, etc.) : Health / Medical condition we should know about: Other (non-food) requests or preferences: Anything else you would like us to know? What is your joy and passion? What is your line of work? Are you willing to use your phone/tablet/computer less on this trip? 🙂 *How Do You Plan to Pay? *How Do You Plan to Pay?CheckWells Fargo Bank TransferPaypal Online (Add 3%) Submit Registration * Indicates a required field.
