Empress Tours Wellness Retreat Registration Form
Standard online registration form for retreat participants.
Participant Details
Full Name
*
First Name
Middle Name
Last Name
Age
*
Gender
Nationality
Occupation
City & Country of Residence
*
Phone Number(WhatsApp Preferred)
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Emergency Contact Name
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Emergency Contact
Retreat Selection and Accommodation
Which retreat are you registering for?
*
Yoga Retreat & Tour – Central Region (28th–31st August 2026)
Camping Retreat – Eastern Region (18th–31st September 2026)
Decolonize The Body – Volta Region (23rd–26th October 2026)
Northern Region Adventure (20th–23rd November 2026)
Bono Region Wellness Tour (18th–21st December 2026)
Accommodation Preference
*
Shared Room(Ghc3000)
Private Room(Ghc4000)
Couple's Room (where available Ghc5300)
Have you attended an Empress Tours™ retreat before?
*
Yes
No
Health, Accessibility, and Participation
Do you have any medical conditions we should know about?
Do you have any allergies?
Are you currently taking any medication?
Do you have any dietary preferences?
Vegan
Vegetarian
Gluten-Free
Other
If other dietary preference, please specify
Do you have any injuries or physical limitations that may affect your participation?
Are you comfortable participating in yoga, hiking, dancing, and other wellness activities?
*
Yes
No
With Modifications
Can you swim?
*
Yes
No
Do you have any special accommodation or accessibility requirements?
Travel, Motivation, and Experience
Where will you be travelling from?
What inspired you to join this retreat?
What are your personal goals for this retreat?
Have you practiced yoga before?
*
Never
Beginner
Intermediate
Advanced
Have you attended wellness retreats before?
*
Yes
No
Which activities are you most excited about?
Yoga
Meditation
Dance & Movement
Hiking
Cultural Tours
Other
How did you hear about Empress Tours™?
Would you like to join our WhatsApp community for updates and future retreats?
*
Yes
No
Media Consent and Payment
Please Make Payment To:Mobile Money Account Number: 0274863441 Account Name: Joshua Akrashie Network: AirtelTigo OR Bank Account Number:4531 0800 6327 7299Bank Account Name:Shakiba Shamor Richards Bank Name: Absa Bank SEND SCREENSHOT TO WHATSAPP FOR CONFIRMATION
Which payment option are you choosing? Deposit At Least Ghc555 to secure your spot. Payment Deadline Ends 20th August. There are no refunds
*
Please Select
Full Payment
Deposit Only
Payment Plan
Have you paid your deposit?
*
Yes
No
Payment Reference / Transaction ID
Date of Payment
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Agreements and Signature
May we take photographs and videos during the retreat for promotional use?
*
Yes
No
I understand that wellness activities involve some physical activity and I participate at my own risk.
*
Yes
I agree to follow all retreat guidelines and respect fellow participants.
*
Yes
Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
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