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Retreat Application Form
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Your name, please
*
First
Last
Date of birth
*
Email
*
Contact number
*
Gender
*
Female
Male
Full address
*
Are you coming alone?
Yes
No
Who is your room partner, if accompanying:
Do you suffer from any health conditions, injuries or disabilities?
Do you have any allergies:
Tell us about your meditation or yoga experience, if any:
Retreat dates attending
*
7 days retreat: 17-23 Oct 2019
5 days retreat: 17-21 Oct 2019
Based on the accommodation types available, which one do you require?
Single room (limited spaces)
2 individuals sharing
3 individuals sharing (same gender)
By which means are you planning to pay?
*
By bank transfer (will email you account details)
By cash (in one of our locations)
How did you hear about our retreat?
google search
facebook advert
akanista newsletter
friend recommendation
flyer
other
Anything you'd like to know?
Name
Apply now
