Booking form: workshops at Viveka Gardens
Om! We're looking forward to hosting you at Viveka Gardens.
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Please complete this form and make your payment (see the end of the form). See you soon. Om Shanti.
* Required
Email address
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Your email
name
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Your answer
mobile and/or landline (both preferred)
Your answer
Name and date of workshop
see the website for yoga and nidra day retreats
vivekagardens.com
October 11th Friday Night Nidra £13
November 15th Friday Night Nidra £13
December 13th at Bromley Yoga £20
December 14th Nidra at North London Yoga Centre (please book with NLYC)
January 17th Friday Night Nidra
February 14th Friday Night Nidra
March 13th Friday Night Nidra
Other:
How did you hear about Viveka Gardens or this workshop
search engine
facebook posting
facebook promotion
word of mouth
flyer or poster
Other:
If you would like to receive the newsletter please opt in here
http://eepurl.com/bnDb4X
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I send a monthly newsletter and sometimes special offers
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landline
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emergency contact
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emergency contact email
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Your answer
emergency contact mobile
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emergency contact landline
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previous yoga experience (briefly)
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Your answer
what do you hope to gain from the workshop? (briefly)
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Your answer
Can you offer or would you like a lift? Where are you coming from? Fiona will try to match for lift sharing.
Your answer
Please let us know if you are affected by any of these. Please be in touch if you'd like to talk it over.
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heart condition
diabetes/glaucoma
neck or back injury
osteoporosis
recent major surgery
childbirth in the last 12 months
depression, grief
mental health condition (optional disclosure)
could be pregnant
no health condition
Other:
Please give details or add anything else you think we should know about.
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Please tell us about any food allergies (write 'none', if none)
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promotion code or offer (if any)
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Please indicate how you are paying
Payment in full required on booking. The workshop fee is transferable up to 1 week before the workshop start. You are welcome to transfer your place to a friend (no additional cost) or you can transfer onto another workshop for a £11 admin fee. Cancellation refund possible (minus 20%) if we are able to fill your space up to one week before workshop. Should we have to cancel the workshop you will be refunded in full but we cannot pay for any travel you may have bought. Each participant to complete a form, please.
internet banking FJ Law 090132 48396382 and put your name as reference
paypal: fiona.law{at}
hotmail.co.uk
(please add 5% if using paypal - 65p for FNN, £2.50 for day retreats)
cheque payable to Fiona Law in advance in person or by post to Viveka Gardens, West Leigh, Crediton EX17 6BL
cash in person (paid in advance - your booking is not confirmed til payment)
Amount paid and any notes (eg names of other people you are paying for or have paid for you)
Your answer
I agree to take full responsibility for myself and for my personal property. The decision to participate in the activities is my own responsibility. In addition I agree that I will not hold Viveka Gardens responsible for any injuries or damages that might result from my participation in any of the activities. 'Sign' by typing your name and date
Your answer
Thank you. Now please LET US KNOW you have completed the form and sent payment, using this email, fiona.law{at}
hotmail.co.uk
. See you soon. Om Shanti.
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