Awakening Sundays Registration ~ Rosemary Garrison Yoga

Personal Information

Name*

First Last

Email*

Enter Email Confirm Email

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Phone*

Class Cost Options*

Pricing (Sliding Scale) - Individual Session
Pricing (Sliding Scale) - Full Series

Payment Option (Sliding Scale) - Individual Session*

Payment Option (Sliding Scale) - Full Series*

Which Day(s) are you Registering for?

How did you hear about us?

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 information on future Teacher Trainings?*

Yes
No

Would you like to receive information on future 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:*

Dietary Information

Do you have any dietary restrictions?*

No
Yes

Please Explain:*

Emergency Contact Information

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email

Relationship*

Additional Message / Information

Your signature below certifies that the information provided herein is true and correct, and that you accept the outlined pricing and terms of participation in the Rosemary Garrison Yoga Retreat on the first Sundays of January - June, 2023, in West Marin, CA.

Acknowledgement*

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

Your participation in this retreat may include photographs on a few occasions. Your signature certifies that you release the use of these images to Rosemary Garrison Yoga for use with marketing and design.

Acknowledgement*

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

Signature*

Total

$0.00

Name

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