August Elemental Practice Retreat booking form Your first and last name Your email Your phone number (mobile) Your address Special dietary requirements Current physical activities How did you first hear about us? Please give details (how long, how often, what style, etc.) of your yoga and meditation background Please mention any relevant medical history (including any serious injuries in the past, whether fully healed or not) I am coming on my own, but I'm happy to shareon my own, and I want a single roomwith a friend (sharing a twin room)with my partner (sharing a double room) Friend's / partner's name A €100 supplement will be applied to your balance if you require a single room Please check with us about single room availability before booking I am paying: By Bank transferOnline with PaypalTransfer from another courseGift voucher Title of the course you're transferring from Date Voucher number, or if unknown, date and name of the person who gave it to you Can we add your email to our mailing list? We send about six newsletters per year with news from the farm and special offers on our courses. You can unsubscribe at any time. We will not share your email address with anyone. No thanksYes please I agree with the Terms and Conditions Book now
