Salt Spring Centre of Yoga

Annual Family Yoga Retreat Registration
July 31 - August 4, 2008
Please complete a registration form for each participant, unless you are registering as a family.
All fields with * must be filled out in order for this form to be submitted to us.

1. Personal Information:

* Full Name:
* E-Mail:
Phone (Day):
Complete Address:

2. How did you hear about us? (please comment as needed)

3. Please list any Food Allergies:

4. Please indicate your level of yoga postures: (please comment as needed)

5. Please list any pre-existing health conditions: (ie. high blood pressure, active asthma and pregnancy stage), active
injuries and prescribed medications that you will be taking at the time of the program.

6. Dates Attending:

7. Retreat Fees: Please list all persons attending, select applicable daily rates, and calculate total. If you are hoping to register for indoor housing, please contact us first to verify availability. Due to noise considerations, indoor housing accommodation for families is limited to children over the age of 12. All children and youth must be accompanied by an adult.

DEFINITIONS: Youth - 13 to 18 years old. Child - 3 to 12 years old. Full Day - count one evening plus one morning/midday as
a full day when calculating shorter stays .

NAME	Age of Child/ Youth	Daily Rate = Tuition + Accommodation	Full Days Attending	Total
1.				$
2.				$
3.				$
4.				$
5.				$
			TOTAL:	$

8. PAYMENT METHOD: Credit Card Personal Cheque / Money Order

All fees must be paid in full to book your reservation. Rates are quoted in Canadian dollars and include all applicable taxes.

If you wish to pay by credit card, please contact us by telephone at (250) 537-2326. Your credit card number will not be
kept in our files subsequent to processing your payment. Please do not under any circumstances send your credit card
information by e-mail. We also take Canadian or US cheques and/or money orders. Payments in US funds will be credited
toward program fees at the prevailing exchange rate.

The Salt Spring Centre of Yoga
355 Blackburn Rd., Salt Spring Island, BC, Canada V8K 2B8 Phone: 250-537-2326 Fax: 250-537-2311
Email: yoga@saltspringcentre.com