Yoga Retreat South India and Dubai-Oct 1^st to 16^th 2010

Registration and Waiver Form

South India only……. Including Dubai ……….

Participant Information
Your name
Date of birth
Nationality
Home Phone,
Cell Phone,
E-mail
Departure city, date and time
Address
Emergency notification Address
Emergency notification phone
Special dietary needs
Information on Yoga Practice:
Your style of Yoga
How long have you been practicing Yoga
Preferred level of yoga practice
How many times a week do you practice
Your hope/goal in this retreat
Have you been hospitalized in past 6 months?
Any physical conditions that might affect your ability to do yoga
Where did you get information on our Retreat?	From Retreat Organizer, Dilshad……………. Other Teacher (Name)………………………… Yogaworks’ notice Board…………………….. Picked up a card from…………………………. Other friend……………………………………………

Any other information that you would like to provide us with, to facilitate us to serve you better:

I agree to the following:

I agree that Yoga Retreat in India and Dubai from Oct 1^st to Oct 16^th 2010 conducted by Dilshad Keshwani and other service providers associated with this package shall not be held responsible for any damages, loss or delay.

I agree to assume all risks associated with the trip and agree that no liability will attach to Dilshad Keshwani’s group or other service providers for any personal injury, illness, delay, loss or damage to property or health. Neither Dilshad nor her associates shall be held liable or responsible for any expenses including but not limited to lodging, meals and transportation incurred by delays or other annoying issues outside of their control. In the event of any contingency due to man-made or natural disaster, Dilshad and her associates have right to change the route and the itinerary.

This Yoga Retreat package price includes Yoga, accommodations, meals at a set time and location, as well as excursions set on the itinerary. If I choose to make other meal arrangements or not participate in any part of the group itinerary, no part of the package price is refundable due to non-participation. I am aware that all excursions offered as “optional”, alcoholic beverages, International flights and visas, room service in the hotel, laundry and local or international calls from the hotel, Ayurvedic and beauty treatments and other incidentals are not included in the package price.

I have reviewed the itinerary on the website and the travel tips. I understand that $500 deposit needs to be paid to reserve my spot by July 10^th 2010. I need to pay $1000 by Aug 10^th 2010 and the balance to be paid in full by Sept 1^st 2010. After July 10^th 2010, the deposit is non-refundable. In case I cannot join this retreat for any reason, I may choose to send a friend, not already registered in the program, to take my spot, with a charge of $100 as processing fee. Submission of this registration form constitutes acceptance of these terms and conditions.

I have read the above and consent herewith.

Print name:

Signature:

Date: