Registration Form

Name*

FirstLast

Gender*

Female
Male

Age*

Phone*

Email*

Address*

Street AddressAddress Line 2CityState / Province / RegionZIP / Postal CodeCountry

Please put NA if an address field is not applicable.

Please provide brief details of any medical conditions you have (allergies, injuries, heart conditions, etc). If none, please enter "none".*

Are you pregnant?*

Yes
No
N/A

Emergency Contact Person *

Emergency Contact Number*

How long have you been practicing yoga?*

Please select the retreat that you are booking for and the amount to be paid. (Normal Fee applies for bookings after 15th Mar, 2019).*

Please make your payment via funds transfer or telegraphic transfer. Your registration will be confirmed upon receiving payment. Please email ompulence@gmail.com for transfer details.

Cancellation & Refund Policy
For early bird retreat rate, a non-refundable 30% deposit of your total Fee is required to secure a booking by 15th Mar 2019. The balance amount is due on 15th June 2019. For normal retreat fee, a non-refundable deposit of 30% is required to secure a booking. The balance amount is due on 15th June 2019.

To reap the full benefits of the yoga that is practised at the Retreat, attendance at all meditations, yoga classes and mindfulness workshops is mandatory, unless you are not feeling well. Please inform your instructors. I hereby agree that I have read the terms and conditions of this Yamanashi Japan Yoga Retreat organized by Carol Cheong Wai Mun and I agree to abide by these rules and to participate in all activities. I agree to take full responsibility for the decision to participate in all Retreat activities and mindfulness practices. In addition, I will not hold either Carol Cheong Wai Mun or Fernando Augusto Oliveira Vaquer de Pinho responsible for any injuries or damages that may result from the participation in Retreat activities.

Have you read and understood the Retreat Terms & Conditions and do you agree to them?*

Yes
No

The Ompulence Retreat Registration Form can be submitted once all the fields are completed and you have read, understood, and agreed to the Retreat Terms & Conditions. Once the form is submitted, Ompulence Retreat will be in contact to complete the registration process with you. Thank you.

Name
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Ompulence Retreat

We organise hatha yoga retreats (Sivananda Tradition) and mindfulness practices in Bhutan, Chiang Mai and Bali.

Registration Form

Yamanashi Yoga Retreat 2019

Registration Form