Costa Rica - Retreat Application Form


Name *
Address *
- $500 deposit due at time of booking. - 50% of room total, minus $500, is due January 5th, 2018 - Final payment is due by February 10th, 2018. - Payments are non-refundable, however payments ARE transferable to a replacement attendee. - A credit card must be provided with your reservation. Payments will be charged to that account automatically on the payment due dates. - Payments made in full by check in advanced of the payment due dates may receive a $50 discount. - 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: *
What type of Yoga do you prefer (you may select more than one): *
Please indicate your interest in the following (1: no interest / 10: high interest):
Are you planning to travel alone but interested in being paired with another person for room sharing?
This is not a guaranteed option.
Date *