Registration Form Please complete the form below – fields marked with * are mandatory. Full Name* Age* Address* City/Town* Postal Code/Zip* Telephone Number* Email* Room preferences:* (ie: Private Room (single), Semi-Private (couple sharing bed or 2 singles) Emergency Contact* Emergency Contact's Phone Number* How are you connected to your emergency contact?* (ie: partner, parent) Previous Yoga Experience* (ie: briefly describe your current practice frequency, years of practice) Please list any dietary restrictions* Please list any medications or conditions we should be aware of* What benefits are you expecting from your retreat experience? Any other comments or questions? We'd love to hear them! How did you hear of Retreat? Δ
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