Costa Rica Retreat Application : Radiance Yoga

Yoga Retreat to Costa Rica

Your Name *

Date *

Address *

City *

State *

Zip *

Phone *

Your Email *

Birth Date *

Emergency Contact Name *

Emergency Contact Phone *

Relation *

How did you hear about this retreat? *

Facebook or Instagram Ad

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Radiance Student

OtherOther

If Other, please tell us below.

Room Selection *

Double Occupancy Bungalow Two Queen Beds ($2999)

Please tell us if you have arranged to share a room with someone. Otherwise we will arrange roommates.

Do you have any injuries or health conditions that we should know about?

Is there anything else you would like to tell us, or ask us?

Checkboxes *

I hereby acknowledge that I have read and understood the terms and conditions of this retreat.