Umbria, Italy - Retreat Registration Form


Name *
Address *
- $750 deposit reserves your place in the retreat. - Half the remaining balance is due April 1st. - Final balance is due by July 1st. - After August 1st, retreat costs are nonrefundable, but will be considered on a case-by-case basis providing a substitute is available from the waitlist. - Cancellation must be made in writing. - Payments can be made by cash, personal check from a US bank, or PayPal. Credit Cards accepted for a 3% service charge. - The Mindfulness Center reserves the right to cancel retreats up until 30 days prior if there is a concern with lack of reservations and if it elects to do so will refund deposit money. We regret that travel and flight payments made by attendees are non-reimbursable in the event of retreat cancellation.
I agree to and acknowledge the reservation policies. *
In participating in the programs and activities that are provided for me by The Mindfulness Center and Retreat Leaders I do hereby waive, release and discharge The Mindfulness Center and Retreat Leaders from any and all responsibilities or liability for injuries or damages, including negligence, resulting from my participation in any activities. I agree that by participating in the retreat activities I do so entirely at my own risk and volition. Furthermore, I hereby release The Mindfulness Center from liability for any injury or illness that I may incur, now or in the future as a result of participating in the activities offered to me. I understand that it is my choice to participate in as many or few of the retreat activates as I choose. *
I acknowledge that either (select one):
How many years of experience do you have with each of the following: * All levels welcome.
What type of Yoga do you prefer (you may select more than one): *
*Premium spaces are available on a first-come, first-served basis. **For a shared suite, we will pair you with someone; you will each have your own sleeping space in the suite. Available on a first-come, first-served basis.
Are you planning to travel alone but interested in being paired with another person for room sharing?
This is not a guaranteed option.
Date *
Thank you for your application. We will contact you shortly regarding your application and method of payment.