Yoga Getaway Yoga Getaway*April 12-14, 2019May 3-5, 2019June 21-23, 2019July 19-21, 2019August 30 - September 1, 2019September 20-22, 2019October 4-6, 2019Select the weekend you would like to attend.*** Receive 20% off any Personal Retreat days before or after the Aug. 31 - Sept 2 getaway. Contact the office for more information (email@example.com) ***Guest InformationName* First Last Email* Email PhoneAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country AccommodationFeesFees include tuition (classes and evening programs) and accommodation (lodging, vegetarian meals and snacks, tea bar and all facility usage). Commuter rates include tuition (classes and evening programs), vegetarian meals and snacks, tea bar and all facility usage). GST will be added to all fees.While every effort will be made to provide your first choice for accommodation, on-site options fill up fast. Please also select your \"2nd Choice\" and \"3rd Choice\" options and your first choice option will be put on the waiting list in case it becomes available.First Choice*[Select]$325 (Commuting to the Centre**)$375.00 (Camping - May-September only)$495.00 (Shared Room - up to 3 persons per room)$530.00 (Shared Room w/ Ensuite - 2 persons)$540.00 (Private Room w/ Shared Bath)$575.00 (Private Room w/ Ensuite)**Meals are included in the Commuting rate.Second Choice*[Select]$325 (Commuting to the Centre**)$375.00 (Camping - May-September only)$495.00 (Shared Room - up to 3 persons per room)$530.00 (Shared Room w/ Ensuite - 2 persons)$540.00 (Private Room w/ Shared Bath)$575.00 (Private Room w/ Ensuite)**Meals are included in the Commuting rate.Third Choice*[Select]$325 (Commuting to the Centre**)$375.00 (Camping - May-September only)$495.00 (Shared Room - up to 3 persons per room)$530.00 (Shared Room w/ Ensuite - 2 persons)$540.00 (Private Room w/ Shared Bath)$575.00 (Private Room w/ Ensuite)**Meals are included in the Commuting rate.Shared Accommodation I prefer a single gender room Which gender?FemaleMaleDiet and HealthWe offer a lacto-vegetarian yogic diet (no meat, fish, eggs, onions or garlic). Please list all dietary allergies that require medical attention and their severity (ingesting vs. being in contact). Also please list any additional dietary concerns or intolerances.Please list any dietary allergies and / or restrictions:*Please list any health conditions or issues:*(e.g. high blood pressure, active asthma, pregnancy stage, active injuries and prescribed medications that you will be taking at the time of the program.)Stay Longer?Many of our guests like to arrive earlier or leave later than the Yoga Getaway weekend and indulge in a few extra days of relaxation, yoga classes and wellness treatments. For extended stays we offer the Personal Retreat option.Personal Retreat Dates I would like to extend my stay at the Centre Early Arrival Date* When would you like to arrive at the centre?Late Departure Date* PromotionsDiscount Offer Bring a friend (or friends) For those staying at the Centre, we offer a $20 discount for both you and your friend(s) (in Shared Accommodations only). If you're commuting or camping, the discount is $10 each. Your Friend's Name(s)First NameLast Name Are you purchasing this as a gift? Yes, this is a gift for my friend Acknowledgments and PaymentHow did you hear about this program?*Friend / Relative / Yoga TeacherSocial MediaInternet SearchMount Madonna CenterEmail NewsletterOtherHelp us understand where to best share our Centre with the world.Let us know where!Yoga Instruction and Liability Waiver and Release* I have read and understood the Yoga Instruction and Liability Waiver and Release and agree to its terms. Cancellation Policy* I have read the Salt Spring Centre's Cancellation Policy and agree to its terms. Centre Guidelines I have read and agree to the Centre's Guidelines. Newsletter & AnnouncementsYes, I would like to join the SSCY mailing list.No, thank you.Stay connected with us. The Salt Spring Centre sends out a monthly newsletter with information about our upcoming programs, our community, announcements and interesting articles. Occasionally we send out other important announcements. You can unsubscribe at any time.Registration Fee Price: $ 31.50 CAD Upon submitting this form you will be redirected to Paypal to pay online. Once payment is received an email will be sent to you confirming that we have received your application and payment. You will then be redirected back to our site. If you wish to phone in your credit card information, please call us at 250.537.2326. We also accept Canadian or US cheques and/or money orders. Payments in US funds will be credited toward program fees at the prevailing exchange rate.