Reservation Request Form

Please complete one reservation form per traveler.
 
A $500 deposit is required when completing the reservation form. Payment must be made in full and received within 10 days prior to the trip start date. Please call or email with any questions or if you're a late traveler and need an exceptions to this policy 860-501-9642 - This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

See the (Make a Payment) link in the menu to the right of this form. 

Please note cut off for non-refundable policy date per your Destination.
 
Full payment may be made by personal check, money order or you can use a credit card via PayPal.
 
Please contact us for U.S. mailing address.
 
Your Trip Date:*
Trip Name:*
   
Personal Data
First Name:*
Last Name:*
Birthdate:*
Gender:*
Male Female
Mailing Address:*
Address Line 2:
City:*
State/Province:*
Zip/Postal Code:*
Country:*
Contact Number:*
E-mail Address:*
Passport Number:*
Passport Country:*
Expiration (mm/yy):*
Reservation Payment Amount:*
US$500 deposit    
Full payment for trip (indicate amount in US$)
Form of Payment:*
Paypal ($500 Max) Check
(US bank only)
Money Order
Travel Voucher
Details of Check or Money Order:
If you are traveling with someone else please list name/s:
Please type Yes to acknowledge that all rooms are non smoking
Contact person in case of emergency:*
Relation to you:*
Contact Number:*
City / State:*
   
Travel Information
Arrival Date:
Time:
Airline / Flight #:
Departure Date:
Time:
Airline / Flight #:
   
Health Information
Do you have any health conditions (asthma, allergies, heart conditions, etc.) or are you taking medications that we should know about?:*
Do you have any physical limitations that may affect your participation in the yoga sessions that we should be aware of (back conditions, knee/ankle problems, recent injuries, vision, hearing, etc.)?:
   
Yoga Experience
Do you have any yoga experience?*
How long have you practiced yoga?*
How often do you currently practice?*
What type of yoga do you practice? (e.g. Iyengar, Ashtanga, Sivananda, Vinyasa Flow, Power, Anusara, Hatha, non-specific, etc.
   
Participant Agreement
 
I, the undersigned, have read, understood and agree to the above Cancellation Policy and Liability Waiver and Assumption of Risk.
Name of Participant:*
Signature:
Date:
Amazing Yoga Travel Trip Date:*