Retreat to Scotland | Radiance Yoga

Scotland Retreat Application

Please read the terms and conditions before starting this application.

Once your application has been accepted and our room choice confirmed you will be required to pay a $1000 non-refundable deposit.

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

Google Search

Radiance Student

Other

If Other, please tell us below:

Room Selection (Choose One)*

Please let us know your preferred set up*

One King Sized Bed

Two Twin Sized Beds

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?

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

Radiance Yoga, 701 Prince St, Alexandria, VA 22314
Tel: 703.535.8282 | Email: info@radiance-yoga.net