REGISTRATION FORM: Women in the Round 2020 Wellness Retreat w/ Linda Meacci and Dreama Phoenix (Feb 8-15, 2020)
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
WOMEN IN THE ROUND 2020 -- Participant Name *
WOMEN IN THE ROUND 2020 -- 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
What type of room would you like (select one)? [NOTE -- All prices are per person.] *
For Double Occupancy, please select one of the following.
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. The food is fresh and localy sourced -- the cooks do not have access to all of the ingredients and/or preparation options that you may be accustomed to at home. Each villa has a fully equipped kitchen, and you are welcome to prepare your own snacks or to have some of your own food on hand as a supplement to ensure your individual needs are met.] *
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 November 8, 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 November 8, 2019. ON OR AFTER November 8, 2019, the Full Retreat Fee must be paid at the time of registration. PLEASE SELECT YOUR PAYMENT METHOD FOR REGISTRATION. [NOTE: A 3% 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 also receive an email with payment and mailing instructions.]
If paying by Credit Card (via PayPal): You will receive an email containing a PayPal invoice within 2 business days. You can then pay the invoice via PayPal's secure online payment processing system.
PAYMENT OF REMAINING BALANCE (due November 8, 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 If you cancel ON OR BEFORE November 8, 2019, your payment(s) will be refunded, minus the $500 CANCELLATION FEE. If you cancel AFTER November 8, 2019, your payment(s) will be refunded, minus the $500 CANCELLATION FEE, ONLY IF your spot can be filled from a wait list. *
TRAVEL INSURANCE ADVISEMENT: Linda Meacci and Linda Meacci Yoga Instruction cannot be held responsible for weather, travel issues, or other circumstances beyond their control that may affect the continuance of the retreat or your ability to participate in the retreat. It is HIGHLY recommended that you purchase travel insurance (including trip cancellation coverage) to cover unforeseen circumstances that might arise before or during your trip. *
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. *
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.