* First Name:

* Surname:

Gender (M/F):

Date of Birth:

Full Address:

City:

Postcode:

Country:

* Telephone number:

* Email Address:

I come to the yoga detox retreat with: Please select one Alone Another friend doing yoga Don’t know yet

Level of experience with yoga: Please select yoga level of experience Never done before Beginner Intermediate Advanced Yoga teacher

I heard about this yoga retreat via:

I choose the following option(s):

shared room (€950)

single occupancy room, if available (€1250)

I will:

pay a non-refundable deposit of €200 to Seeds of Yoga asap to secure my place and the remaining balance before the 16th april 2015

pay the full amount to Seeds of Yoga asap

* I have read and agreed upon the terms and conditions