2026 Panchakarma Healing Journey

2026 Panchakarma Healing Journey
All sections must be completed. Click on each of the following section tabs to open. If you have any problems filling in the form please contact us.
- Name (as shown on your passport)
  
  First NameLast Name
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Gender
- Date of Birth
  
  MonthDayYear
  Date
- Phone Number
  (Include area code if applicable)
- Email
  example@example.com
- Emergency Contact Name
- Emergency Contact Phone Number
- Passport No:
- Country Passport Issued:
- Passport Expiry Date:
  You must have a minimum of 6 months available from our return date.
- You will submit information relating to your health and wellbeing directly to Vaidyagrama via a link on their website.
- PANCHAKARMA HEALING JOURNEY - 2026
- Please note:
  1. The $1500 AUD Support Fee is payable in cash to Mary Girishaa before or in India.
  2. The Panchakarma component is in $USD and paid directly to Vaidyagrama. A $1000 deposit is required at the time of regsitration to secure your place in the group. Payment arrangments are detailed on the Vaidyagrama website. The balance, plus taxi fees, take home medicines and any incidentals are paid at the completion of your stay.
- Please read carefully
  
  Aware WellBeingTerms & Conditions
  
  Listed rates are per person.
  
  Retreat participants are required to obtain comprehensive travel insurance that includes cancellations.
  
  If the India programme is unable to proceed due to flight cancellations or travel restrictions the organisers will help you liase with Vaidyagrama to recover your deposit.
  
  The organisers will not be held responsible for any expenses which may be incurred in preparation for the India programme, including airline tickets, travel delays, flight cancellations or illness or changes in Govt regulations or travel restrictions.
  
  Aware WellBeing Disclaimer
  
  I acknowledge that the instructions given throughout the retreat are given only as guidance and are not intended to replace medical care. I therefore accept that it is my responsibility to advise the retreat facilitators of any existing conditions including any recent injury, illness, surgery or commencement of pregnancy; in order for them to assist me to adapt the practices for my needs. I acknowledge that it is my responsibility to do the practices within my own limits to prevent injury and expressly waive any claim I may have against Mary Girishaa Westley and any other staff or volunteers representing Aware WellBeing for any injury or loss sustained by me resulting from the practice of Ayurveda or Yoga under their instruction.
  
  It is acknowledged and agreed as a condition of participating in the services and activities including accommodation and related services, that the operators, occupiers, instructors and their employees, agents, contractors and volunteers shall not be under any liability for death or any personal injury, loss or property damage which may be sustained or incurred to any person at any of the programme venues or any adjoining or related lands. I agree to the Terms & Conditions and take full responsibility for my actions while traveling to and from the course venue and during my time at the venue. I acknowledge that I am fully responsible for myself during my stay or when participating in any activity.
- Please ensure that you have entered all the required information and read the T&C and Disclaimer before submitting this form, then click the SUBMIT button below:
- Click to confirm that you accept this disclaimer:
- If you have questions or need more information, please contact phone either Tim or Mary Girishaa:
  
  Tim:
  
  0407 275 712 or meditationwithtim@gmail.com
  
  Mary Girishaa
  
  0400 494 166 or marygirishaa@gmail.com
  
  To return to website click here.
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