Portugal Retreat : 24th Feb-2nd March 2019
Registration form / Formulaire d'inscription
Email address *
First Name / Prénom *
Your answer
Last Name / Nom *
Your answer
Telephone *
Your answer
City / Ville *
Your answer
I am / Je suis *
Required
Name of the person/people you want to share a room with (if applicable) / Nom de la personne avec qui vous souhaitez partager la chambre
Your answer
What kind of yoga do you practice? (Vinyasa, Ashtanga, Hatha, Yin, Yoga Nidra, Meditation...) / Quel genre de Yoga pratiquez-vous ? *
Your answer
How long have you been practicing? / Depuis combien de temps pratiquez-vous ? *
Your answer
Injuries / Blessures ? *
Your answer
Dietary requirements or allergies ? / Régime alimentaire ou allergies ? *
Your answer
How did you hear about this retreat ? / Comment avez vous entendu parler de cette retraite ? *
Your answer
Are you pregnant? Êtes vous enceinte ? *
Required
Emergency contact / En cas d'urgence
First Name / Prénom *
Your answer
Last Name / Nom *
Your answer
Their relationship to you / Leur lien avec vous *
Your answer
Mobile telephone including country code / Portable *
Your answer
E-mail *
Your answer
Accommodation and Packages (Choose one. Earlybird ends January 5) *
Promo code
Your answer
Payments can be made in cash or online transfer to the below bank details / Paiement et aarhes sont à faire en liquide ou par transfert bancaire à :
Account name: Gemma Vassallo
Bank: Credit Agricole
IBAN : FR76 1820 6000 5765 0191 1822 893
BIC : AGRIFRPP882
The Serious Stuff
- To take part in this Yoga retreat with Gemma, you acknowledge the following:

- Gemma, the venue, and any other related entity are not liable for any injury, illness, or mishap that may occur during your travel to and from the retreat and during your stay.

- You are responsible for taking your own travel insurance for your own protection and you are solely responsible for all your belongings during your travels. Insurance is highly recommended and can be purchased by your local provider.

- All efforts will be made for you to share a room with your nominated person, but cannot be guaranteed.

- You are in good health and are ready physically and mentally for 7 days of dynamic and restorative yoga and meditation practices. If you require clearance from your doctor to participate in such activities, you have done so before booking this retreat and will present your medical certificate if it is requested by Gemma.

- You are prepared to pay for the deposit in full, in Euros, one week from sending in this completed form. A 50% deposit is required to reserve your place. You understand the deposit is non-refundable.

- Cancellation policy: 50% deposit is required to secure your place. The deposit is non-refundable. Full payment is required no later than the 24th January 2019. For cancellations before 24th January, the deposit is non refundable and you will receive a refund of 50% of any further monies paid. Should you cancel on or after the 24th January, no refunds will be given.

- A payment plan may be negotiated on request for the full investment price.

- You are ready for the experience of a lifetime!!

Click to agree *
Thank you ! Merci !
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