Yoga is Mindfulness Registration Form Full Name: Email: Phone (day):  Phone (evening): Address: City, State, Zip: Birthday: Special Dietary Needs:  Emergency Contact Name: Someone not traveling with you Emergency Contact Phone: Have you been hospitalized for any reason in the past 6 months? If so, why? Physical conditions that might affect your ability to do yoga: Yoga experience and level: What style(s) do you normally practice? How many years have you been practicing? How frequently do you practice? How did you hear about this retreat? What do you hope to get out of this retreat? Additional information you would like to provide us with:   By submitting this reservation form I agree to the following: I agree that Shaina Traisman and other service providers associated with this package shall not be held responsible for any damages, loss or delay. I agree to assume all risks associated with the trip and agree that no liability will attach to Shaina Traisman or other service providers for any personal injury, illness, delay, loss or damage to property or health. Shaina Traisman shall not be held liable or responsible for any expenses including but not limited to lodging, meals and transportation incurred by delays or other annoying issues outside of our control. Our package prices, unless otherwise indicated, include accommodations, meals at a set time and location, as well as excursions and activities set on the itinerary. Shaina Traisman reserves the right to change the program schedule if necessary. If you choose to make other meal arrangements or not participate in any part of the group itinerary no part of the package price is refundable due to non-participation. A non-refundable $500 deposit will reserve your space. Reservation is effective upon receipt of this registration form and payment of the deposit. If you are unable to come due to any reason you may send someone in your place or contact us for information on wait-listed individuals. If only the deposit has been paid, the new participant should pay you the deposit and you should notify us of the name change. Because our prepayments are not refundable, we highly recommend that you protect your investment with travel insurance for your trip. All participants must fill out a registration form in order to participate. Submission of the registration form along with receipt of payment constitutes acceptance of these terms and the cancellation policy.