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?*YesNoIf 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 the Bunkroom and pay the full fee of $342I would like to book into the Bunkroom and pay a $100 deposit, $142 June 1, $100 September 1I would like to book into a twin room (to share with someone else) and pay the full fee of $367I would like to book into a twin room and pay a $100 deposit, $167 June 1, $100 September 1I need to be in a single room because... please detail your reason in the comment section below. Only two available. Melissa will then confirm with you. Total cost $399.I would love to be there but financially this isn't possible. I would be interested in finding out how I can reduce my fees. Please ring Melissa on 0274612000. Thank you.Fees must be paid by electronic transfer. The bank details will be automatically emailed to you after you register. If you do not receive these, please email me for the bank details. 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 1st. Dietary Requirements*I have special dietary requirements and will pay an extra $20 to cover this.I will be fine with a menu that includes dairy, gluten and meatIf 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 before September 1, 2020 and will incur a $30 processing fee. No refunds are available after September 1, 2020 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, Melissa Gardiner or Wainui Park) 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 pleaseNo thank youManaia's Mailing List* Please sign me up to Manaia's Mailing List (quarterly 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 newsletters, thank you. Any comments or queries...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. If you don't have any Yoga gear, which includes mat, bolsters, blankets, eye bags, belts or blocks, then please include a note here to say you will need all of the gear provided. Gear can be picked up from Melissa, at class, the week before the Retreat and returned the week after, as I don't have enough space in my car to bring all of the props! This iframe contains the logic required to handle Ajax powered Gravity Forms.