Zen yoga retreat at ubud reservation form

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retreat reservation
ubud


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Detailed Registration Form - (One participant per registration form)

Please select your options:

Zen Retreat in Ubud schedule for 2010 - 2011 on:

July 11 - 16, 2010

January 2 - 7, 2011

July 25 - 30, 2010

January 16 - 21, 2011

August 15 - 20, 2010 (Fully Booked)

January 30 - Feb 4, 2011

Aug 29 – Sept 3, 2010 (Fully Booked)

February 13 - 18, 2011

September 12 -17 (Fully Booked)

February 27 - Mar 4 , 2011

Sept 26 – Oct 1, 2010 (Fully Booked)

April 3 – 8, 2011

October 24 - 29, 2010 (Fully Booked)

April 17 – 22, 2011

November 14 - 19, 2010 (Fully Booked)

May 1 – 6, 2011

December 5 - 10, 2010

May 15 – 20, 2011

December 19 - 24, 2010

May 29 – June 3, 2011

December 26 - 31, 2010

June 12 - 17, 2011

* Although the availability is updated daily it might be that a retreat is no longer available. Please use this form to check availability.

Occupancy

Single Occupancy

Twin Share (1 bed)

Twin Share (2 beds)

If you are sharing a room, what is the name of your room mate? Please note: Each participants must fill this registration form separately. Personal Information
Name:	*
Home Address :
Country :
Home Telephone Number:	*
Office Telephone Number:
Mobile Number:
E-mail address:	*
Re-enter your email address:	*
Arrival Flight Date:
Arrival Flight Details to Bali:	Airline : Flight #
ETA (estimated time arrival) :
Departure Flight Date:
Departure Flight details from Bali:	Airline : Flight #
ETD (estimated time departure) :
Will you stay with us prior to the retreat? :	Yes No
If yes, date of arrival at Zen Retreat:
If no, where will you stay prior to the retreat?:
Telephone number of your accommodation prior to the retreat? (if apply)
Will you stay with us after the retreat? :	Yes No
If yes, date of departure from Zen Retreat:
If no, where will we take you after the retreat?:
Have you been to Bali before? :	Yes No
Your Birthday:
Yoga Experience
Type of Yoga:
Do you practice meditation on a regular basis? :	Yes No
Have you practiced meditation in the past?:	Yes No
Meal Preferences (please note that we do not serve red meat or pork)	I am a vegetarian I am a pescetarian, (I am a vegetarian but eat fish) I am a vegan (I don’t eat any meat, eggs,dairy products) I have none of the meal preferences above
If you have allergies or food you dislike, please specify :
Please explain if you have any physical disorder that we should be aware of :
Special Request :
How did you hear about us...?	Please Specify: (Such as Google, Magazine, Web Link, etc...)
We will confirm your reservation within 36 hours.