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1-Week Authentic Yoga Retreat
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Yoga Retreat
Application Form
Application Form - 1-Week Authentic Yoga Retreat
Personal Information :
First & Last Name * :
Email Address * :
Phone Number (optional):
Gender :
- - Select Gender - -
Male
Female
Language(s) Spoken :
Your Age Group:
- - Select Age Group - -
18-30
31-45
46-60
60+
Nationality :
- - Choose Country - -
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua And Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas, The
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Botswana
Bouvet Island
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Rep
Chad
Chile
China
Christmas Island
Cocos (Keeling) Is
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Croatia (Hrvatska)
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji Islands
Finland
France
French Guiana
French Polynesia
Gabon
Gambia, The
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea
Korea, North
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands Antilles
Netherlands, The
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Norway
Oman
Pakistan
Palau
Panama
Papua new Guinea
Paraguay
Peru
Philippines
Pitcairn Island
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Helena
Saint Kitts And Nevis
Saint Lucia
Samoa
San Marino
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad And Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands (British)
Virgin Islands (US)
Western Sahara
Yemen
Yugoslavia
Zambia
Zimbabwe
Travel information :
When is the start of your course (Date/Month/Year)
Number of Travellers :
- - Select - -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Yoga Experience :
How would you put your yoga level? :
How would you put your yoga level?
Beginner
Intermediate
Advanced
Why do you want to experience this retreat?
(Check all that apply)
Physical fitness
Peace of mind / stress relief
General Inquisitiveness
Holiday/ relaxation
Seeking higher meaning to life
Other
Health Information :
The following questions are here to help us understand you and make the retreat more productive. The answers to these questions will be kept in strict confidence.
Are you currently taking medication for any physical or psychological condition?
Yes
No
Do you have any chronic physical limitations or disabilities?
Yes
No
Do you have a history of psychological or emotional illnesses, or issues?
Yes
No
Do you have a communicable disease?
Yes
No
Have you had a serious illness or major surgery within the last five years?
Yes
No
Are you currently pregnant or trying to become pregnant?
Yes
No
If you answered YES to any of the above questions, please provide us with more relevant details as it would pertain to retreat safety. As well, please describe if there is anything else you feel we should know about you OR with regards to your participation in the program here:
Message * :
By submitting this Application form, you agree to the
Terms & Conditions
of participation
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