REGISTRATION FORM: "Yoga from the Inside Out: Practicing from the Power of Our Center” Day Retreat with Linda Meacci and Zo de Runtz (August 31, 2019)
WHEN YOU HAVE COMPLETED THE registration form in its entirety and applied your e-signature in Section 8, you may print a copy for your records by following the instructions at the bottom of the form. . . . . When you are ready to submit the form, click the "SUBMIT" button at the bottom of the form.
* NOTE: Fields marked with an asterisk (*) are required.
Section 1: Participant Contact Information
YOGA FROM THE INSIDE OUT Day Retreat (August 31, 2019) -- Participant Name *
YOGA FROM THE INSIDE OUT Day Retreat (August 31, 2019) -- Participant Name
Participant Address *
Participant Address
Participant Phone *
Participant Phone
ENTER NUMBERS ONLY. DO NOT USE PLUS SIGN (+), DASH (-) OR OTHER SYMBOLS.
What type of phone is the above? *
Section 2: Emergency Contact Information
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone - Primary *
Emergency Contact Phone - Primary
ENTER NUMBERS ONLY. DO NOT USE PLUS SIGN (+), DASH (-) OR OTHER SYMBOLS.
What type of phone is the above? *
Emergency Contact Phone - Alternate (optional)
Emergency Contact Phone - Alternate (optional)
ENTER NUMBERS ONLY. DO NOT USE PLUS SIGN (+), DASH (-) OR OTHER SYMBOLS.
What type of phone is the above?
Section 3: Yoga Experience and Injuries
Briefly describe your yoga experience, including your level, how long you have been practicing, the primary style(s) of yoga you practice, and the frequency of your current practice (i.e., how many times per week or per month).
Briefly describe any injuries or concerns you may have relative to practicing yoga. **NOTE: Please review/update this information in person with the instructor at the start of the retreat.
Section 4: Special Dietary Needs
What special dietary needs do you have? *
Check all that apply.
Section 5: Required Payment(s)
PAYMENT IS REQUIRED WITH REGISTRATION -- To reserve your space in this retreat, you must complete and submit the online registration form AND submit payment by check.
Please make checks payable and mail to: ZO FLOW YOGA, 6819 Reynolds Street, Pittsburgh, PA 15208.
Section 6: Terms and Conditions
Note: You must click the "I have read and agree" box and enter your initials in the space provided after each paragraph.
CANCELLATION POLICY: If you wish to cancel your registration, you must notify Zo de Runtz of Zo Flow Yoga BY EMAIL at zo.deruntz@gmail.com. If you cancel ON OR BEFORE August 4, 2019, your payment(s) will be refunded, minus a $50 CANCELLATION FEE. If you cancel AFTER August 4, 2019, your payment(s) will be refunded, minus a $50 CANCELLATION FEE, ONLY IF your spot can be filled from a wait list. *
WAIVER OF LIABILITY: You, the participant, assume all responsibility of risk, injury, and personal discomfort by registering for this retreat. It is your responsibility to inform the instructor immediately before, during, and/or after any yoga session or other activity of any pain, discomfort, and/or existing medical situations. With your signature, you release Zo Flow Yoga and all instructors and facilitators participating in this retreat from any and all liability for personal injury, pain or discomfort that may result from your participation in any activities, classes, or lessons associated with this retreat. *
Section 7: PARTICIPANT SIGNATURE
PARTICIPANT ELECTRONIC SIGNATURE (REQUIRED): You must check the box and type your full name in the space below. By doing so, you certify that the information you have provided on this registration form is truthful and accurate to the best of your knowledge and that you have read and agree to the Terms and Conditions outlined above. *
If you would like to print a copy of your completed form for your records, press the keystroke combination "CTRL-P" (press "CTRL" and "P" simultaneously) to bring up your computer's print menu. . . . . Or, right-click with your mouse and select "Print" or "Print preview" in the pop-up box. . . . . When you are ready to submit your registration form, click the "SUBMIT" button below.
NOTE: Once you click "SUBMIT," you will no longer be able to print your form.