Zen yoga retreat at ubud reservation form

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 2008 on:

April 20 - 25 2008

May 4 - 9 2008

June 8 - 13 2008

June 22 - 27 2008

July 6 - 11 2008

July 20 - 25 2008

August 3 - 8 2008

August 17 - 22 2008

August 31 - Sept. 5 2008

Sept 28 - Oct. 3 2008

Oct 12 - 17 2008

Oct 26 - 31 2008

Nov 2 - 6 2008

Nov 23 - 28 2008

Dec 7 - 12 2008

Dec 21 - 26 2008

Zen Retreat in Ubud schedule for 2009 on:

Dec 28 2008 - Jan 2 2009

April 19 - 24 2009

Jan 11 - 16 2009

May 3 - 8 2009

Jan 25 - 30 2009

May 17 - 22 2009

Feb 8 - 13 2009

May 31 - June 5 2009

Feb 22 - 27 2009

June 14 - 19 2009

March 8 - 13 2009

June 28 - July 3 2009

March 22 - 27 2009

July 12 - 17 2009

April 5 - 10 2009

July 26 - 31 2009

Occupancy

Single Occupancy

Twin Share (2 beds)

Twin Share (1 bed)

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 of Origin:
Home Telephone Number:	*
Office Telephone 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
Are you a vegetarian?:	Yes No
If yes please specify if you eat:	Fish Eggs Sea Food Dairy Product
Do you have allergies or some food you dislike?:	Yes No
If yes please enumerate :
Please explain if you have any physical disorder that we should be aware of :
Special Request :
We will confirm your reservation within 36 hours.