REGISTRATION FORM: "il dolce momento" Tuscany Yoga Retreat w/ Linda Meacci (Oct 19-26, 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
TUSCANY RETREAT 2019 (Oct 19-26) -- Participant Name *
TUSCANY RETREAT 2019 (Oct 19-26) -- 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).
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
LODGING FIRST CHOICE -- What type of room would you like (select one)? [NOTE -- All prices are per person.] *
For Double Occupancy, please select one of the following.
LODGING SECOND CHOICE -- In case your first choice in not available (select one)? [NOTE -- All prices are per person.] *
Section 5: Special Dietary Needs
What special dietary needs do you have? [PLEASE 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.] *
Check all that apply.
Section 6: Required Payment(s)
PAYMENT REQUIRED WITH REGISTRATION -- To reserve your space in this retreat, you must complete and submit the online registration form AND submit payment. If you register BEFORE July 18, 2019, at minimum a $500 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 July 18, 2019. If you register ON OR AFTER July 18, 2019, the Full Retreat Fee must be paid at the time of registration. PLEASE SELECT YOUR PAYMENT METHOD FOR REGISTRATION. [NOTE: A 2% processing fee applies to credit card payments.] *
IF PAYING BY CHECK: 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 receive an email with payment and mailing instructions.]
IF PAYING BY CREDIT CARD (via the PayPal secure payment processing platform): 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 2% processing fee will be added to your invoice.)
PAYMENT OF REMAINING BALANCE (due by July 18, 2019) -- What method of payment would you like to use to pay your remaining balance (you will receive a reminder when it is due)? *
Section 7: 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: There is a $500 CANCELLATION FEE for all cancellations. (The cancellation fee is covered by the $500 Nonrefundable Deposit, if one has been made.) If you wish to cancel your registration, you must notify Linda Meacci Yoga Instruction BY EMAIL at info@lindameacciyoga.com. If you cancel ON OR BEFORE July 18, 2019, your payment(s) will be refunded, minus the $500 CANCELLATION FEE. If you cancel AFTER July 18, 2019, your payment(s) will be refunded, minus the $500 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. It is recommended that you 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. *
Section 8: 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.