Move•Eat•Breathe registration form
July 15-22 | Pura Vida Retreat & Spa
Name
*
First Name
Middle Name
Last Name
Email address
*
example@example.com
Phone Number
*
Would you like to receive emails from Elizabeth/Senz about future retreats, offerings, and other studio happenings?
*
Yes, please!
No, thanks!
Would you like to receive emails from Alison/Be at Peace Coaching + Mentorship about future retreats, offerings, and other events?
*
Yes, please!
No, thanks!
If you are staying in a ***double occupancy room*** , do you need a roommate?
*
Yes
No
Not applicable (staying in solo accomodations)
If you are staying in a ***double occupancy room*** with a roommate/someone you already know, please put their name and email address below (write N/A if not applicable):
*
Please tell us about food allergies, or dietary requirements/requests:
*
Please tell us about your yoga experience, background and preferences (check all that apply):
*
Brand New: just beginning and ready to get started!
Experienced Beginner: familiar, but I do not have a consistent practice
Seasoned yogi: longtime yoga practioner
I mostly do hot yoga
I mostly do unheated yoga
I love all forms of yoga!
Please tell us about any injuries, health conditions or physical limitations we should know about:
*
I understand and acknowledge that payments are NONREFUNDABLE, but they are transferable. I acknowledge that I am responsible for filling my spot once the payment has been made, and I will be in coordination with the retreat hostesses to let them know who is filling my spot.
*
I agree to this policy
I understand that I must PAY IN FULL to reserve my spot in the retreat, unless I have spoken to the retreat hostesses and they have agreed to give me a specific payment plan.
*
I agree to this policy
ROOM SELECTION: please select the room option you are reserving
*
Mountain View Suite 1 (double occupancy/2 queen beds) $3,200 per person
Mountain View Suite 2 (single occupancy/1 queen bed) $3,400 per person
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Mountain View Suite 1 (double occupancy room)
$
3,200.00
Select number of people you're booking this room for
1
2
Mountain View Suite 2 (single occupancy room)
$
3,400.00
Select number of people you're booking this room for
1
2
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
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the form.
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