Living Yoga Retreat Registration
February 14-16, 2020
Bell Valley Retreat
Boonville, California
Name *
Email *
Phone number *
Emergency Contact (name and phone) *
Please briefly describe your background with yoga and meditation:
Any injuries or health conditions Amy should be aware of? *
Room selection: *
Required
Roommate (if applicable)
Dietary restrictions: *
Required
Payment method *
If you opted to pay by credit card (PayPal), I will email you an invoice within 24 hours.
I am now ready to pay: *
Liability Agreement: I release Amy Hillman-Siracusa from liability, which may arise from any claims made by me or any third party in connection with my participation in the retreat. *
Required
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