Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

How did you hear about this retreat?

Travel Information

We will need: arrival time, flight number, airline, and airport along with departure info. If you do not have it yet respond "do not have this info"

Food Allergies/ Diet Restrictions*

menu's are usually plant based and may include fish, eggs and dairy

Special Notes*

physical limitations, injuries, special occasion celebrations, etc.

Yoga Experience

in addition: note anything you are working on/ towards in your current practice

What are you most looking forward to during your retreat?

What if anything are you nervous about this retreat?

What is your intention going into this retreat? What are you hoping to gain or experience?

You are AMAZING!

with love yoga