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Galapagos Registration Form
Cell Phone #:
Emergency Contact (Name & Number):
Name of Roommate:
1. Please describe your yoga experience (No experience is ok :)
2. Do you have any injuries, old or new? Please explain. Recent injuries will require a doctor’s note of approval.
3. What would you like to get out of this retreat?
4. Are there any specific areas of your body that you would like to work on improving strength or flexibility?
5. Are there any specific asanas (yoga postures) that you would like to go over?
6. Which room would you like to reserve for your stay? Please indicate if this will be a single, double, triple occupancy? Room #?
7. Do you have any allergies? Special Diet? Vegan? Gluten free? This location will need to know of any special dietary requirements in advance to accommodate your needs
8. How did you hear about Namaste Yoga Retreats?
Cancel 100+ days prior to start of retreat 100% Refund, minus your non refundable deposit
Cancel less than 100 days- No Refund unless room can be filled. If room is filled, 100% Refund, minus your non refundable deposit
I understand that if my roommate cancels I have the option of cancelling according to the terms listed above or paying the single rate for the room I have booked. Please sign and date that you have read and understand the cancellation policy
Space is limited. To reserve your spot today, please send your registration form and check to:
402 Moraine Street
Marshfield, MA 02050
Please make checks payable to "Tricia Glynn"
Please contact me if you have any questions.