REGISTRATION FORM: This Moment on the Mountain 2017 Fall Yoga Retreat w/ Linda Meacci (Oct 22-27, 2017)
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
Participant Name *
Participant Name
Participant Address *
Participant Address
Participant Phone *
Participant Phone
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
What type of phone is the above? *
Emergency Contact Phone - Alternate (optional)
Emergency Contact Phone - Alternate (optional)
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). **NOTE: Beginners are welcome!
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: Lodging Preference
What type of room would you like (select one)? [Prices are PER PERSON.] *
For DOUBLE or TRIPLE occupancy, please select one of the following.
Section 5: Special Dietary Needs
What special dietary needs do you have? *
NOTE: The cooks will do their best to address special dietary needs; however, they may not be able to fully address all needs in all cases.
Section 6: Required Payment
To reserve your space in this retreat, you must complete and submit the online registration form AND submit payment. If you register BEFORE July 15, 2017, a minimum $300 NONREFUNDABLE DEPOSIT must be paid at the time of registration (or you may pay the full retreat fee if you wish), with the BALANCE DUE by July 15, 2017. ON OR AFTER July 15, 2017, the full retreat fee must be paid at the time of registration. PLEASE SELECT A PAYMENT OPTION.
How do you plan to pay the remaining balance of the retreat fee when it is due?
Please make all checks payable to "LINDA MEACCI YOGA" and mail to ... Linda Meacci Yoga, 646 Maryland Ave, Pittsburgh, PA 15232 USA ... [NOTE: You will also receive an email with payment and mailing instructions.]
If paying by credit card (PayPal):
You will receive an email containing a PayPal invoice within 48 hours. The invoice can then be paid via PayPal's secure online payment processing system. (NOTE: A 3% PayPal Processing Fee applies.)
Section 7: Terms and Conditions
Note: You must click the "I have read and agree" box after each paragraph.
RETREAT REGISTRATION AND PAYMENT: To reserve your space in this retreat, you must complete and submit the online registration form AND submit payment, per the instructions in Section 6 REQUIRED PAYMENT. Your space is not guaranteed until your deposit (if registering before July 15, 2017) or full payment (if registering on or after July 15, 2017) is received.
CANCELLATION POLICY: A Cancellation Fee of $300 applies to ALL cancellations. If a Nonrefundable Deposit has been made, it may be applied toward payment of the Cancellation Fee. If you wish to cancel your registration, you must notify Linda Meacci Yoga BY EMAIL at If you cancel ON OR BEFORE July 15, 2017, your payment(s) will be refunded, less the Cancellation Fee. If you cancel AFTER July 15, 2017, your payment(s) will be refunded, less the Cancellation Fee, ONLY IF your spot can be filled from a wait list. NOTE -- Linda Meacci and Linda Meacci Yoga Instruction cannot be held responsible for weather, travel issues, or other circumstances beyond their control. When you book your airline ticket, you may want to consider purchasing trip cancellation insurance.
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 all instructors and facilitators participating in this retreat from any and all liabilities that result from your participation in any activities, classes, or lessons associated with this retreat.
ELECTRONIC SIGNATURE OF PARTICIPANT (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.