Haramara Retreat 2013

Personal Information

Name*

FirstLast

Email*

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Address*

Street AddressCityState / Province / RegionZip / Postal CodeCountry

Phone

Where did you learn about Rosemary's teaching?*

Housing

Room Selection*

Shared Casa Grande (Dorm, 2 bath) - $1575 Early Reg. / $1775 After Jan. 15
Triple Room (3 to a room) - $1825 Early Reg. / $2025 After Jan. 15
Double Room (2 to a room) - $1975 Early Reg. / $2175 After Jan. 15
Single Room (private) - $2950 Early Reg. / $3150 After Jan. 15

Payment Option*

Yoga Experience & Interest

Level of Yoga Practice*

Beginner / less than 100 practice hours
Intermediate / 100-1000 practice hours
Advanced / over 1000 practice hours

Are you a yoga teacher?

Yes
No

Would you like to receive the Rosemary Garrison Yoga Newsletter? *

Yes
No

Would you like to receive information on future Teacher Trainings?*

Yes
No

Gender*

Female
Male
Transgender

Would you like to receive information on future Women's Retreats?

Yes
No

Medical Information

Are you under the care of a physician and/or chiropractor for any physical or medical condition?*

No
Yes

Please Explain:*

Do you currently have any injuries or health conditions?*

No
Yes

Please Explain:*

Do you have any food, medication, or environmental allergies?*

No
Yes

Please Explain:*

Dietary Information

Do you have any dietary restrictions?*

No
Yes

Please Explain:*

Emergency Contact Information

Name*

FirstLast

Address*

Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry

Phone*

Email

Relationship*

Additional Message/Information:

Acknowledgement*

I Agree to the Terms of the above Agreement of Release & Waiver of Liability

Acknowledgement*

I agree to the Terms of the above Media & Copyright Agreement

Signature*

Yoga retreat pricing above includes lodging, three meals per day, and related taxes and fees; airfare/transportation costs are not included in retreat pricing. Retreat deposits are non-refundable; in the event of cancellation made prior to January 15, 2013 your entire payment will be refunded less the $500 deposit. By digitally signing below I certify that the information I have provided herein is true and correct, and I accept the outlined pricing and terms of participation in the Rosemary Garrison Yoga Retreat on March 23-30, 2013 at Haramara Retreat.

Haramara 2013

Registration

Personal Information

Housing

Yoga Experience & Interest

Medical Information

Dietary Information

Emergency Contact Information