Italy Retreat Registration Form

Each person in your party must fill out a registration and payment form to participate.

Your space will be considered filled when we receive your registration form(s) and payment has cleared. Payment constitutes acceptance of both these terms and the Wildspirit Yoga cancellation policy.

Full Name

First NameLast Name

Gender

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Home Phone

Area CodePhone Number

Cell

Area CodePhone Number

E-mail

Accomodations: The Castle provides Single Occupancy and Double Occupancy rooms. Please request your room in the payment section below. Room requests are first come, first served. We will do our best to honor your request.

What is your room preference? See prices below for further info on costs.

If you chose a Double Occupancy Room, please list the name of your preferred roommate, if known. Otherwise, leave blank and we will find you a roommate.

Dietary Preferences

Please specify other dietary preferences

A $750 deposit is required to reserve your space and to complete this registration. The balance of your payment is due by August 1, 2011. If, however, you'd like to pay in full today, just select the payment for your preferred rooming option, in addition to the deposit.

Payment Method

Credit Card Information

Italy Singe Occupany Room$3,490.00

Italy Double Occupancy Room$2,490.00

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Payment Policy: A $750 non-refundable deposit is required to reserve your space. The remaining payment balance is due August 1, 2011.

All payments are non-refundable.

Prices do not include airfare or transportation.

The demand for spots in the Wildspirit Yoga retreats is extremely high; therefore, all payments are non-refundable. Please make very certain that the dates and time commitment to this retreat will work for you before sending any payment.

Credits Policy: In the event the participant cancels their reservation before the balance is due, the $750 non-refundable deposit may be transferred to a future retreat provided that each of the following guidelines are met:

1. The retreat is Wildspirit Yoga hosted retreat.

2. The credit is used for a retreat scheduled no later than 1 year of the

original retreat start date.

Please note there is a $100.00 administration fee when a credit is transferred to another person or future retreat. Reservation is effective upon receipt of this registration form and payment. If you are unable to attend the retreat, a refund is granted only if you have a medical or family emergency. Cancellation must be received in writing.

Liability: I/we agree that Wildspirit Yoga and its instructors shall not be held responsible for any damage, loss or delay. I/we agree to assume all risks associated with the trip and agree that no liability will attached to Wildspirit Yoga for any personal injury, illness, delay, loss or damages to property or health. Wildspirit Yoga reserves the right to change the program schedule if necessary. Wildspirit Yoga shall not be held liable or responsible for any expenses, including but not limited to lodging, meals, and transportation incurred by delays or other uncontrollable issues outside of our program.

In the event that you need to cancel because of unexpected circumstances, and as a general practice, we highly recommend that you protect your investment with travel insurance for your trip. To purchase travel insurance you can go to www.travelsecure.com or call (800) 873-9855.

Italy Retreat Registration Form

Payment

Credit Card Information*

Terms and Conditions

Credit Card Information