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Sound Silence Stillness Retreat
South India Devotion Retreat
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Turiya Meditation Training
Sound for Wellbeing with Nitya Mohan
Wellness
Ayurveda
Private Classes & Counselling
Yogi's Kitchen Blog
Home
About
About Kookaburra Yoga
Calendar
Gift Vouchers Form
Retreats
About our retreats
Sound Silence Stillness Retreat
South India Devotion Retreat
Bluff Knoll Yoga & Hiking Retreat
Yoga & Cleanse 7 Day Retreat Margaret River
Bali Yogic Healing Journey
South India Yoga Ayurveda Retreat
Classes
About our Classes
Timetable
Online
Teachers
Courses
About Our Courses
Absolute Beginners Yoga
Yoga Relax Meditate Course
Introduction to Meditation
Programs
Mohans Empowerment Through Yoga
Yogi's Kitchen Cooking Classes
Turiya Meditation Training
Sound for Wellbeing with Nitya Mohan
Wellness
Ayurveda
Private Classes & Counselling
Yogi's Kitchen Blog
Book your Yoga & Cleanse Retreat
at Kookaburra Creek
Yoga & Cleanse Retreat
booking form
Personal Details
*
Indicates required field
Name
*
First
Last
Email
*
Date of Birth
*
Gender
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Mobile Number
*
If you are attending with a friend/partner you'd like to share with please enter their name
*
2020 Yoga & Cleanse dates
Select your retreat date/s
*
Sat 5th Sept to Sat 12th Sept
Accommodation
Select accommodation option
*
$1540 Shared room
$1640 Shared room (payment plan)
$2750 Luxury apartment for 1 person
$2850 Luxury apartment for 1 person (payment plan)
$3750 Luxury apartment couple
$3850 Luxury apartment couple (payment plan)
Payment Options (pay upfront or choose payment plan)
Choose payment option
*
full upfront payment
6 month payment plan (6 payments)
Health
List any allergies, food allergies/intolerances and dietary considerations
*
List any health issues and medications you are currently taking
*
Emergency Contact Person
Name
*
First
Last
Phone Number
*
Payment Options
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 payment plan please be in touch.
Final steps to register
Click the
SUBMIT
button below to go to our
BOOKING PAGE
.
Please select the option to
BOOK A CLASS
Select the
retreat option above
and
retreat date
on calendar
Follow the prompts to
make your payment
You can
pay securely
through Paypal, credit card or direct deposit.
You will receive a tax invoice and email confirmation.
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 this information on our website.
Submit & Proceed to Payment
