RETREAT REGISTRATION FORM

Name

First Name

Last Name

Personal contact cell phone number

In case we need to contact you while you are travelling with us

Full address

Dietary Requirements

please let us know if you have any dietary requirements, eg. vegetarian. If you are coming with someone who is not participating in the workshop, please list their dietary requirements here too.

Medical Conditions

please let us know if you have any medical conditions you think we should know about. If you are coming with someone who is not participating in the workshop, please let us have details of their medical conditions too.

Emergency Contact Name

Emergency Contact Number

Insurance

I confirm that I have travel insurance cover which includes repatriation costs and medical expenses.

How did you hear about us?

Thank you for taking the time to fill out the form, we really appreciate it.

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RETREAT REGISTRATION FORM