Yoga Vacation Gift Certificate

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1 Price

Select a price.

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CAD $10.00 – Program Price

Number of Guests:

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CAD $20.00 – Price

Number of Guests:

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CAD $30.00 – Price

Number of Guests:

2 People in your group

Guest 1		First Name* Last Name* Genre / Gender* Email*
Guest 1		First Name* Last Name* Genre / Gender* Email*

After completing this form, emails will be sent to everyone in your group to complete their information.

3 Participant Info

	Send me a reminder if I don't register today
First Name *
Last Name *
Genre / Gender *
Téléphone / Phone *
Email *
Ville / City
Prénom du destinataire / Receiver's first name *
Nom de famille du destinataire / Receiver's family name *
Sexe du destinataire / Receiver's Gender *
Nom en cas d'urgence / Name in case of emergency *
Numéro de téléphone du contact en cas d'urgence / Contact phone in case of emergency *
Restrictions Alimentaire* / Dietary restrictions *	Vegan Sans Gluten / Gluten Free Arachides / Peanut Autre / Other The kitchen does its best to offer healthy meals usually including vegan and gluten free alternatives. However, prepared items may contain or come into contact with WHEAT, PEANUTS, TREE NUTS, and MILK. For more information, always ask what is in the food choices before eating and always bring your own stock of prepartion- and refridgerator-free alternatives. Note that guests are not permitted to walk in and out of the kitchen due to health and safety regulations.
Êtes-vous déjà venu avant? / Have you been here before?	Oui / Yes No / Non
Règlement Intérieur/Rules and Regulations *	I have read and accept the rules and regulations of the Ashram. Lire les règlements et politiques Read the rules and regulations
Formulaire de décharge de responsabilité / Liability Form *	I have read and accept the liability form of the Ashram. Lire le formulaire de décharge Read the liability form
Comment avez-vous entendu parlé de nous? How did you hear about us? *
Courriel infolettre / Email newsletter	Francais English Aucune / None Notre infolettre peut facilement être traduite en toute autre langue avec Google Traduction / Our Newsletter is easily translate in any language with Google translate.

4 Payment

Sub Total	$0

Taxes	$0

50% Deposit	$0

Due Now	$0 $0

First Name
Last Name
Card Type
Card Number *
Card Expiration *	Month Year
Card Security Code	usually a 3 digit code on back of card