NYS registration form

Nourish Your Soul Retreats

Registration Form

Next Nourish Your Soul Retreat: to be announced

* Indicates required field

Retreat name and date *

Name *

First

Last

Date of Birth *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Occupation *

Phone Number *

Emergency Contact: Name and number *

How did you hear about us *

Are you pregnant? *

Specific food allergies or dietary requirements *

Relevant medical conditions/injuries *

Please indicate your yoga experience *

Please indicate your meditation experience *

Please indicate what treatment you would like *

Payment
I enclose $150 being non-refundable / non-transferable deposit for the above mentioned retreat.
I enclose $490 being full/final payment for the above mentioned retreat. I understand that full payment must be paid at least one week prior to commencement of retreat. I also understand that if I cannot attend this course for any reason I must notify Nourish Your Soul Retreats as soon as possible. This retreat cost minus the deposit amount may be transferred to another course or refunded - only if your position on the retreat can be filled by someone else.

Choose One *

Deposit of $150 Payment in full $490

Any comments or questions please share here: *

Thanks for taking the time to fill out this form. Once we process the registration we will send you further details of payment, directions to the venue and what to bring with you.

Peace and Light, Seriya & Tanya

If you would like to read more about us personally, and our journey’s you can go to our personal business websites www.akshayahealing.com and www.innerbalancesanctuary.com

If you would like to see some photos from our last retreats and read some testimonials go to our website and FB page:
www.facebook.com/nourishyoursoulretreats
www.noursihyoursoulretreats.com

Submit