The Empowered Self Yoga and Meditation Retreat (February 2024)
Please fill out this form to register for the retreat. Once received, payment instructions will be sent to the email address provided. Please note that room options are based on availability and bookings are not considered confirmed until your payment is received.
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Full Name *
Date of Birth *
Email Address *
Please input your email address again and ensure that both inputs match
Nationality *
Room Request *
If you would like to share a room with a PARTICIPATING friend, please provide your friend's name below.
If you are attending with a NON-PARTICIPATING partner, please provide your partner's name below.
Yoga and meditation experience *
Please tell me a little bit about your experience with yoga and meditation. How many years have you been practicing? If you have a meditation practice, what meditation technique do you work with?
What is your intention for participating in this retreat
If you have had any past trauma or injury, please very briefly describe below. 
How would you like to make your payment? *
Payment is requested in full. Your spot on the retreat is not confirmed until payment is received. Cancellation policy: FULL REFUND until November 30th; 50% REFUND from October 1st until January 15th; NO REFUNDS after January 15th.
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