Retreat Booking Form

Name*
First Last
Email*
Phone*
Address*
Street Address City ZIP / Postal Code
Emergency Contact Details*
Please provide their name, contact number and relationship to you.
Do you have any injuries or health conditions that may affect your participation in this Retreat?*
- Yes
- No
If yes, please provide further information below:
Please note: this information is solely for the use of the teacher (and teaching assistant if required) and will be kept confidential.
Payment*
- I would like to book into a Bunkroom and pay the full fee of $331
- I would like to book into a Studio and pay the full fee of $363.
- The Apartments are now all booked.
Fees must be paid by electronic transfer. The bank details will be sent to you after you register. The full amount is due when booking, or if you would prefer there is the option to pay in installments with the full amount paid by September 20th.
Extras*
- I will bring my own bedding, so no extras for me thank you.
- I would like to pay an extra $20 and have bedding available for me when I arrive.
Bedding includes a pillow, pillowcase, bottom sheet, duvet, blanket, towel and flannel.
Dietary Requirements*
- I have special dietary requirements so will pay an extra $24 to cover this.
- I will be fine with a menu that includes dairy, gluten and meat
If you have dietary requirements please list these in the comments section below.
Cancellation Policy*
- I have read, understand and agree to the Cancellation Policy below.
Refunds are available if one cancels by September 1, 2019 and will incur a $30 processing fee. No refunds are available after September 1, 2019 unless we are able to fill your place from a wait-list.
Terms & Conditions*
- I have read, understand and agree to the Waiver below.
I ackowledge the inherent risks associated with any physical exercise. I accept those risks and enter this Retreat freely of my own decision. I will hold no-one (including Manaia Yoga & Wellbeing or Melissa Gardiner) to blame for any injury, whether physical or mental arising out of my attendance at the Retreat, associated exercises, following of any printed literature and use of the premises.
Would you like a receipt e-mailed to you?*
- Yes please
- No thank you
Manaia's Mailing List*
- Please sign me up to Manaia's Mailing List (bimonthly newsletters) so I am kept in the loop about Melissa's events, classes, expos and wellbeing services.
- I am already regsitered on the Manaia database to recevied the bimonthly newsletters, thank you.
Any comments or queries...
Yoga Props*
Melissa will be supplying the bulk of the Yoga props. If you have any props that you can bring with you please list these above so I can make sure we have enough props for everyone. The more props the better! If you don't have any Yoga gear, which includes bolsters, blankets, eye bags, belts or blocks, then please include a note here to say you will need all of the gear provided.

Contact Details