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 2011 - 2012 on:

November 13 - 18 (Fully Booked)

May 27 – June 1, 2012

Nov 27 - Dec 2 (Fully Booked)

June 3 – 8, 2012

December 4 - 9 (Fully Booked)

June 24 – 29, 2012

December 11 - 16 (Fully Booked)

July 1 – 6, 2012

December 25 -30 (Fully Booked)

July 8 – 13, 2012

January 1 - 6 (Fully Booked)

July 29 – August 3, 2012

Januari 8 - 13, 2012

August 12 – 17, 2012

January 15 – 20, 2012

August 26 – 31, 2012

January 29 – February 3, 2012

September 9 – 14, 2012

February 12 – 17, 2012

September 23 – 28, 2012

February 26 – March 2, 2012

October 7 – 12, 2012

March 11 – 16, 2012

October 28 – November 2, 2012

March 25 – 30, 2012

November 11 – 16, 2012

April 1 - 6, 2012

November 25 – 30, 2012

April 8 - 13, 2012

December 16 – 21, 2012

April 22 – 27, 2012

December 23 – 28, 2012

May 6 – 11, 2012

December 30, 2012 – Jan 4, 2013

* 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 one of our retreats 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.