Thailand Adventure

Thailand Adventure

21/1 - 19/2/2027
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
- Gender*
  
  MaleFemale
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Phone Number*
  (Include area code if applicable)
- Email*
  example@example.com
- Emergency Contact Name *
- Emergency Contact Phone Number*
- Full Name as shown on Passport
- Passport No:*
- Passport Expiry Date:*
  You must have a minimum of 6 months available from our return date.
- Country Passport Issued:*
- Date of Birth*
  
  MonthDayYear
  Date
- Time of Birth
  Contact the medical records section of the hospital you were born if you don't know it already)
- Place of Birth:*
- Q1: Do you have any relevant existing physical and mental health conditions that the retreat organiser should be aware of?*
  
  Yes (provide details below)No (continue to Q2: Dietary requirements)
- If you answered 'yes' to the above, please select all that apply:
  
  Dairy FreeGluten FreeOther (please give details below)
- If you answered 'yes' to the above, please provide details:
- If you are taking medication or receiving treatment for any of the above, please list here (specify the form of medication/treatment & if you have approval from your health care practitioner to undertake a yoga practice):
- Q2: Do you have any special dietary requirements?*
  
  Yes (please indicate below)No (continue to Section 4)
- If you answered 'other' to the above, please provide details here:
- Full payment due 31/10/2026. Deduct deposit where relevant*
  
  $500 - Non-refundable DepositArun - $6450 (1st Floor/Front/Double & Single Bed/Large Front Balcony )Dharuni - $5850 (Ground Floor/Front/Double Bed/Large Front Veranda)Benjawan - $5550 (1st Floor/Back/Twin Beds/Private Balcony)Chaba - $5550 (1st Floor/Back/Double Bed/River Facing Verandah)Esarn - $5550 (Ground Floor/Side/Double Bed/Side Verandah)Farang - $5550 (Ground Floor/Back/Twin Beds/Private Verandah)Garuda - $5550 (Ground Floor/Back/Double Bed/River Facing Verandah)
- Choose from the following payment options:
  
  By bank transfer:
  Account name: Mary Westley
  BSB: 637000
  Account No: 721126714
  
  Please include in the reference field the month and year of the retreat and your surname, e.g. Thai2027Smith
  
  By credit card:
  Can be arranged via Paypal using the email marygirishaa@gmail.com
  
  Add 3% to the total to cover fees.
  
  Please email marygirishaa@gmail.com with the details of your payment.
- Please read carefully
  
  Listed rates are per person.
  
  The nominated non-refundable deposit is per person and is required to confirm your registration.
  
  Retreat participants are required to obtain comprehensive travel insurance that includes cancellations.
  
  If you need to cancel your registration the following refund guidelines apply:
  
  - Up to 30 days before the retreat commences you will receive a full refund less the non-refundable deposit.
  
  - Up to 15 days before the retreat commences you will receive a 50% refund less the non-refundable deposit.
  
  - Within 15 days there will be no refund.
  
  If a retreat is cancelled by Aware WellBeing all payments received from the participant towards the retreat will be refunded in full.
  
  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 click to confirm that you accept this disclaimer:*
  
  I have read the above and accept the terms of this disclaimer
- If you have questions or need more information, please phone Mary Girishaa on 0400 494 166.
  
  Alternatively email her: marygirishaa@gmail.com
  
  To return to website click here.
- 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:
- Should be Empty: