Wild Woman 2024 Registration Personal InformationName* First Last Email* Enter Email Confirm Email Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone*Housing*Platform tent/ Double - $1,225 before September 1st, 2024/$1,425 after September 1st, 2024Platform tent/ Single - $1,525 before September 1st, 2024/$1,725 after September 1st,, 2024Bunkhouse/ Dorm: $1,425 before September 1st, 2024/$1,625 after September 1st, 2024Barn Room/Double or Triple: $1,625 before September 1st, 2024/$1,825 after September 1st, 2024Barn Room/Single: $2,325 before September 1st, 2024/$2,525 after September 1st, 2024Main House/ Double: $2,175 before September 1st, 2024/$2,375 after September 1st, 2024Main House/ Single: $2,975 before September 1st, 2024/ $3,175 after September 1st, 2024Platform - Double*Yoga Retreat Deposit - $395Yoga Retreat Full Payment - Early Reg. - $1,225Platform - Single*Yoga Retreat Deposit - $395Yoga Retreat Full Payment - Early Reg. - $1,525Bunkhouse/Dorm*Yoga Retreat Deposit - $395Yoga Retreat Full Payment - Early Reg. - $1,425Barn Room/Double or Triple*Yoga Retreat Deposit - $395Yoga Retreat Full Payment - Early Reg. - $1,625Barn Room/Single*Yoga Retreat Deposit - $395Yoga Retreat Full Payment - Early Reg. - $2,325Main House - Double*Yoga Retreat Deposit - $395Yoga Retreat Full Payment - Early Reg. - $2,175Main House - Single*Yoga Retreat Deposit - $395Yoga Retreat Full Payment - Early Reg. - $2,975Yoga Experience & InterestLevel of Yoga Practice*Beginner / less than 100 practice hoursIntermediate / 100-1000 practice hoursAdvanced / over 1000 practice hoursAre you a yoga teacher?YesNoWould you like to receive information on future Teacher Trainings?*YesNoWould you like to receive information on future Retreats?YesNoMedical InformationAre you under the care of a physician and/or chiropractor for any physical or medical condition?*NoYesPlease Explain:*Do you currently have any injuries or health conditions?*NoYesPlease Explain:*Dietary InformationDo you have any dietary restrictions?*NoYesPlease Explain:*Emergency Contact InformationName* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone*Email Relationship*Additional Message / InformationYoga retreat pricing above includes lodging, all meals, and related taxes and fees; airfare/transportation costs are not included in retreat pricing. Retreat deposits are non-refundable; in the event of a cancellation made prior to August 21st, 2023, your entire payment will be refunded less the $395 deposit. 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 August 4th-7th 2022, at Bell Valley Ranch, Anderson Valley, 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 NameThis field is for validation purposes and should be left unchanged.
