Italy Retreat 2022 Registration ~ Rosemary Garrison Yoga

Personal Information

Name*

First Last

Email*

Address*

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

Phone*

Housing

Room Selection*

Triple: $2,750 before July 1st, 2022/ $2,950 after
Double: $2,950 before July 1st, 2022/ $3,150 after
Single: $4,550 before July 1st, 2022/ $4750 after

Triple Room*

Double Room*

Single Room*

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 currently a yoga teacher?

Yes
No

Where did you learn about Rosemary's teachings?

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

Yes
No

Gender*

Female
Male
Transgender

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

Medical Information

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

Yes
No

Please Explain*

Do you currently have any injuries or health conditions?*

Yes
No

Please Explain*

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

Yes
No

Please Explain*

Dietary Information

Do you have any dietary restrictions?*

Yes
No

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

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 July 1st, 2022 your entire payment will be refunded less the $575 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 September 17th - 24th, 2022 at Italy Retreat.

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*

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Total

$0.00

Name

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Italy Retreat Form - 2022

Personal Information

Housing

Yoga Experience & Interest

Medical Information

Dietary Information

Emergency Contact Information