Your Trip Date:* |
|
|
|
|
|
Trip Name:* |
|
|
|
Personal
Data |
|
First Name:* |
|
|
Last Name:* |
|
|
Birthdate:* |
|
|
|
|
|
Gender:* |
|
|
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:* |
|
|
Form of Payment:* |
|
|
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 |
|
|
|
Name of Participant:* |
|
|
Signature: |
|
|
Date: |
|
|
|
|
|
Amazing Yoga Travel Trip Date:* |
|
|
|
|
|