Yoga Tandava Program

2016 February 26 – March 5 (7 Mystical Nights) New Delhi - Varanasi - Rishikesh

Registration Form. Please fill in all pages and email to: yoginishambhavi@aol.com and kaphacollective@gmail.com

_____YES! Register me for the following: (One form per registrant, please)

TOTAL PAYMENT: Cost of Program –USD 2150 – 7 Nights. A non-refundable deposit of $ 800.00, is payable immediately to book your space. Early Registration discount up to Nov. 30, 2015 – USD 1950.00 Remaining balance is payable by Jan 7, 2016 to qualify for Early Registration. All other payments after registration deposit, due in full by Jan 30, 2016

PRICE INCLUDES: Program from February 26 – March 5, 2016 Retreat includes flight from Delhi-Varanasi-Delhi. Surface travel Delhi – Rishikesh. Accommodation and meals - morning tea, brunch, evening tea and dinner. Accommodation is on 2 persons sharing a room basis. Select rooms for couples. Single occupancy is available at an extra 800 USD. All accommodations are non-smoking.

You would need to arrive at Delhi Airport on the night of February 26. If only attending the Yoga Tandava program, You will need to book your International return flight from Delhi Airport after 1:00 AM on March 6. Please let us know if you need help with hotel reservations for extra nights and airport transfers.

TRAVEL INSURANCE Cancellation Insurance is strongly recommended as no exceptions to the cancellation provisions can be made. Please understand that any financial loss or emergency medical expense will be assumed by you. Please read the terms and conditions and fully understand the cancellation penalties.

RETREAT CANCELLATIONS The following cancellation charges as a percentage of total price apply subject to a minimum cancellation amount of $750.00 USD Before 90 days $750 60–90 days or more before departure 50% 30-60 days before departure 75% 0-30 days before departure/No Shows 100%

__________ I have read and understood the cancellation and travel insurance clauses.

First name as in Passport: _________________________________________________________

Last name: ____________________________________________________________________

Occupation: ________________________________ Date_____________________________

Address:_____________________________________________________________________

City: _________________________ State: ________ Zip: _______ Country: ______________

Day Ph: ____________________________ Eve Ph: ___________________________________

Email: ______________________________________________________________________

Date of Birth: __________ (MONTH/DAY/YEAR) Time ______ Place_______________

Sex: _____ Citizenship: ______________________________

Passport No: _____________________________________________________________________

If sharing a room, I want to share with: ______________________________________________

Contact Person in case of emergency ________________________________________________

_________________________________________________________________________________

Any Special Requirements/Diet______________________________________________________

_____________________________________________________________________________

Would you like a Personal Vedic Consultation with Yogini Shambhavi (150 USD payable at the retreat): ___________________

Have you been to India before? _______________________________________________________

Have You Attended any of our Programs Before? Please specify____________________________

___________________________________________________________________________

Photograph

PAYMENTS

Bank Wire Transfers: Please notify us when making any transfers. So we can verify the transactions.

ACC. NAME - KAPHA COLLECTIVE LLP M-70 GREATER KAILASH 1 NEW DELHI - 110048

HDFC BANK  B-54A, GREATER KAILASH 1 NEW DELHI - 110048

ACC. NO  - 50200002080653 IFSC CODE - HDFC0000092 SWIFT CODE - HDFCINBBDEL