SHAKTI YOGIS LTD
RETREAT BOOKING FORM AND AGREEMENT
Full Name
*
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
E-mail
example@example.com
How did you hear about us?
*
Please Select
Google
Instagram/Facebook
Other
Retreat Date
-
Month
-
Day
Year
Date
Name of Retreat
*
Injuries, health conditions or concerns
Next of Kin Details, Name and Phone Number
Yoga Experience
Dietrary Requirements
Please Indicate if you would like a massage or therapy. Limited Spaces (please request therapy menu and price, payment will be made direct to the therapist on retreat.)
Yes Please
No Thank you
Other
Room Choice (if available)
Single Ensuite
SIngle Shared Bathroom
Twin Ensuite
Twin Shared Bathroom
If Twin Sharing please add their name
Please Sign here to further agree to Booking Condtions. This form will also be your booking confimation and will be sent to you when the first deposit is paid.
Submit
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