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Sound Silence Stillness 1 Day
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New Year's Eve Sound Silence Stillness Retreat
Turiya Meditation Training
Christmas Solstice Celebration Araluen
Mohans Empowerment Through Yoga
Sound for Wellbeing with Nitya Mohan
Wellness
Yoga Wellbeing Blog
Home
About
About Kookaburra Yoga
Calendar
Gift Vouchers
Retreats
About our retreats
Sound Silence Stillness 1 Day
Margaret River 4 Day Meditation Retreat
Wild Nature 5 Day Southwest Retreat
Bluff Knoll Yoga & Hiking 3 Day Retreat
Yoga & Cleanse Margaret River 8 Day Retreat
Bali Yogic Healing Journey
South India Devotion Retreat
South India Yoga Ayurveda Retreat
Classes
About our Classes
Timetable
Private Classes & Mentoring
Teachers
Courses
About Our Courses
Absolute Beginners Yoga
Yoga Relax Meditate Course
Introduction to Meditation
Programs
Womens Healing Program
Havan Meditation
Yogi's Kitchen Cooking Classes
New Year's Eve Sound Silence Stillness Retreat
Turiya Meditation Training
Christmas Solstice Celebration Araluen
Mohans Empowerment Through Yoga
Sound for Wellbeing with Nitya Mohan
Wellness
Yoga Wellbeing Blog
Book your Retreat
Wild Nature Retreat booking form
Personal Details
*
Indicates required field
Name
*
First
Last
Email
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Mobile Number
*
Gender
*
Date of Birth
*
If you are attending with a friend/partner you'd like to share with please enter their name
*
Retreat Date
Choose One
*
23-27 APRIL 2021
Accommodation
Select accommodation options
*
$1200 SINGLE in shared room in chalet - twin beds
$1500 SINGLE in single room in chalet
$2400 COUPLE Double room in chalet - double bed
$2400 FRIENDS Twin share in chalet - twin beds
$2800 COUPLE Private cottage - double bed
$2800 FRIENDS Private cottage - twin beds
$1800 SINGLE Private cottage - 1 person
Couple/Friends Booking Details
If you are booking for a 2nd person please provide details of the second guest. They will need to complete their own Participation Form.
2nd Participant's Name
*
First
Last
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Email
*
Health
List any allergies, food allergies/intolerances and dietary considerations
*
List any health issues and medications you are currently taking
*
Rate your level of fitness
*
very fit
moderate
not fit
Emergency Contact Person
Name
*
First
Last
Phone Number
*
Carpooling
Please indicate if you would like to share the drive as either a driver or passenger. Anyone carpooling is welcome to leave vehicles in the carpark at Kookaburra Yoga, which for most people coming from Perth on the Albany Highway, is on the way.
Choose One
*
Driver
Passenger
Terms & Conditions
Please read the
Terms & Conditions of Retreat Participation
prior to submitting this form. You must agree to the Terms and Conditions and submit the Waiver of Liability Form prior to attending the retreat.
Payment Options
Full payment confirms your place. On completing this form you will be directed to the payment page to complete the booking process.
If you are unable to pay the whole amount and would like a 6 month payment plan for an extra $100 please select
pay later
and
email us.
If the retreat is cancelled due to COVID you will be offered a place on a rescheduled date or a full refund.
Final steps to register
Click the
SUBMIT
button below to go to our
BOOKING PAGE
.
Select the same
retreat option above
and on calendar
Follow the prompts to
make your payment
You can
pay securely with a credit card.
To pay by bank transfer, Payment Plan or Paypal select Pay later and use the details in the invoice to make your payment.
You will receive a tax invoice email confirmation once your payment is made.
Once you have registered you will receive a
Participation Form
which must be completed prior to attending
A week prior to the retreat you will receive an
Information Email
with details about the retreat, what to bring and what to expect. You can also find all this information on our website.
Submit & Proceed to Terms & Conditions