Thailand Retreat Booking Form 2019

Thailand Retreat Booking Form 2019
All sections must be completed. Click on each of the following section tabs to open. If you have any problems filling in the form please contact us.

1: YOUR PERSONAL DETAILS
Name *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *
(Include area code if applicable)
Email *
example@example.com
Date of Birth *

Month Day Year
Date Date Picker Icon
Gender *

Male Female
Emergency Contact Name *
Emergency Contact Phone Number *

2: YOUR HEALTH AND DIETARY ADVICE
Q1: Do you have any relevant existing health conditions that the retreat organiser should be aware of? *

Yes (provide details below) No (continue to Q2: Dietary requirements)
If you answered 'yes' to the above, please provide details:
If you are taking medication or receiving treatment for any of the above, please list here (specify the form of medication/treatment & if you have approval from your health care practitioner to undertake a yoga practice):
Q2: Do you have any special dietary requirements? *

Yes (please indicate below) No (continue to Section 4)
If you answered 'yes' to the above, please select all that apply:

Dairy Free Gluten Free Other (please give details below)
If you answered 'other' to the above, please provide details here:

3: CHOOSE YOUR ACCOMMODATION
Select your accommodation by clicking on payment box:
THAILAND IMMERSION: 22 Nov - 15 December 2019 (deduct deposit where relevant)

$450 non-refundable deposit $2377 – Standard single room (full payment by 31/7/2019) $2587 – Superior single room (full payment by 31/7/2019) $2087 – Superior double/twin room (full payment by 31/7/2019) $2797 – Deluxe single room (full payment by 31/7/2019) $2297 – Deluxe double/twin room (full payment by 31/7/2019) $250 - Surcharge for bookings after 1/8/2019
Please note:
- Bookings received after 31/7/2019 will incur a surcharge of $250.
- Superior & Deluxe double & twin share arrangements available on request at a discount of $500 per person.
- Registrations for both people to be submitted together.
  Standard rooms have a private bathroom, AC & fan, fridge & balcony/veranda.
- In addition to these features Superior & Deluxe rooms all have slightly different features which may include: newer building; nicer furnishings, kettle, more private locations or a better position in relation to the Mae Kong River and garden etc.
- The earlier you book the better your choice as there are only a limited number of each available.

4: PAYMENT OPTIONS
Choose from the following payment options:

By bank transfer:
Account name: Mary Westley
BSB: 659000
Account No: 35518

Please include in the reference field the month and year of the retreat and your surname, e.g. Oct2019Smith

By credit card:
Click here for Trybooking (2.5% surcharge has been included in the price)

PLEASE NOTIFY US AFTER YOU'VE MADE YOUR PAYMENT:

Please email retreats@2wisewomen.com.au with the details of your payment.

5: SUBMIT
Please read carefully

2WiseWomen Terms & Conditions

Listed rates are per person.

The nominated non-refundable deposit is per person and is required to confirm your registration.

Registrations made after the nominated full payment date will include a surcharge and full payment is required at the time of booking.

It is strongly recommended that you obtain a comprehensive travel insurance for retreats that involve flights or additional travel costs. (A participant once cancelled due to ill health the day before she was due to depart and with a medical certificate from her doctor was able to receive a full refund from the insurance company.)

If you need to cancel your registration for any reason the deposit, and any subsequent payments toward the retreat, may be transferred to another 2WiseWomen retreat being held within 12 months of the notification of cancellation being received by 2WiseWomen, as follows:

- Up to 60 days before the retreat commences will receive a 90% credit for the amount paid.

- Up to 30 days before the retreat commences will receive a 75% credit for the amount paid.

- Up to 15 days before the retreat commences will receive a 50% credit for the amount paid.

- After 15 days there will be no credit given.

If a retreat is cancelled by 2WiseWomen, all payments received from the participant towards the retreat will be refunded in full.

The organisers will not be held responsible for any travel expenses which may be incurred in preparation for the retreat, including airline tickets, travel delays, flight cancellations or illness.

2WiseWomen Disclaimer

I acknowledge that the instructions given throughout the retreat are given only as guidance and are not intended to replace medical care. I therefore accept that it is my responsibility to advise the retreat facilitators of any existing conditions including any recent injury, illness, surgery or commencement of pregnancy; in order for them to assist me to adapt the practices for my needs. I acknowledge that it is my responsibility to do the practices within my own limits to prevent injury and expressly waive any claim I may have against Coralie Casey and Mary Girishaa Westley and any other staff or volunteers representing 2WiseWomen for any injury or loss sustained by me resulting from the practice of Ayurveda or Yoga under their instruction.

It is acknowledged and agreed as a condition of participating in the services and activities including accommodation and related services, that the operators, occupiers, instructors and their employees, agents, contractors and volunteers shall not be under any liability for death or any personal injury, loss or property damage which may be sustained or incurred to any person at any of the programme venues or any adjoining or related lands. I agree to the Terms & Conditions and take full responsibility for my actions while traveling to and from the course venue and during my time at the venue. I acknowledge that I am fully responsible for myself during my stay or when participating in any activity.
Please ensure that you have entered all the required information and read the T&C and Disclaimer before submitting this form, then click the SUBMIT button below:
Please click to confirm that you accept this disclaimer: *

I have read the above and accept the terms of this disclaimer

OUR CONTACT DETAILS
If you have questions or need more information, please phone:
Coralie: 0474 226 448, or Mary: 0400 494 166.

Alternatively email us: retreats@2wisewomen.com.au

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