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Puglia retreat 2024
Use this form to book a place at yogapulia 21 to 27 sept 2024
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Full name
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Email address
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Date of Birth
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Address
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Telephone number (please include the area code)
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Do you have prior experience of Mysore self practice
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If you answered yes to the last question please tell me a little bit about your practice
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Accommodation preferences
Single room (subject to availability, supplement applies)
Shared room (twin)
Shared room (double)
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Do you have any food allergies or dietary requirements (please note all meals are vegetarian)
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No
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If you answered yes to the question above please provide details of any dietary requirements, food intolerances or allergies
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Please provide an emergency contact’s phone number (including area code)
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