What's your name?
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Are you comfortable with sharing a room or do you prefer a single room (for additional fee).
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No preference
I’d prefer a single room
I'd like to share a room with a guest who is joining me
Please enter the name of the guest you'd like to room with:
*
Guest first and last name
Tell us a little bit about yourself and your expectations for attending this yoga retreat.
*
We invite you to share your story so that we can better understand what makes you unique, and what you’re hoping to work on or come away with after this weekend.
What's your experience with yoga? At this retreat, all levels are welcome from complete beginner to advanced.
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Please share a little bit about your practice
Do you have any health concerns or injuries that we should be aware of?
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No
Yes
Please briefly describe your health concerns and/or injuries that we should know about:
*
Are there any allergies, dietary restrictions or preferences that you have?
*
None
Vegetarian
Vegan
Gluten-free
Nut/seed allergies
Other
How will you be arriving to the retreat? We plan to offer a roundtrip shuttle from Midtown for those interested (This is a separate fee of $100/person which goes directly to the transportation service)
I'm interested in the shuttle
I've got transportation covered
Emergency contact
*
First Name
Last Name
Relationship to emergency contact
*
Please Select
Partner/Spouse
Close Friend
Sibling
Parent
Child
Other _____
Emergency contact phone number
*
-
Area Code
Phone Number
Anything else you think we should know that we haven’t covered?
Please feel free to share as much or as little information as you wish.
How did you hear about us?
*
Friend/Family member
Google/online search
Social media
Other
Submit
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