Women’s Deep Rest Retreat Registration Form 16th – 20th October 2020

*Please select/fill in the purple areas. The boxes will expand to fit if needed*

Name:	Date of Birth:
Mobile:	Email:
Address:

Current Body Movement/Exercise Practices:

What would you like to get out of this retreat?:

(Please tick all that apply) STILLNESS RELAXATION STRESS MANAGEMENT

RELIEF FROM NECK or BACK PAIN CONNECTION MOVEMENT OTHER (please specify)

Your Medical History: This helps us to support you further:

(Please tick if you have any of the following) HIGH BLOOD PRESSURE LOW BLOOD PRESSURE

HEART PROBLEMS ARTHRITIS NECK PROBLEMS BACK PROBLEMS ANXIETY

DEPRESSION ADRENAL FATIGUE MENOPAUSAL SYMPTOMS PMT or PMD

Are you pregnant? Y N … If YES, how many weeks?

Have you had surgery? Y N … If YES, please give details

Are you taking any prescription medication? Y N … If YES, please give details

Do you have any injuries? Y N … If YES, please give details

Is there anything else about your health you’d like to share?

Please let us know any food requirements/intolerances:

Organic Accommodation Options:

Twin share (with 2x single beds)	$1595: Oct 2020, 4 nights

Early Bird Special – to be paid in full by 30th June 2020. Deposit of $500 to secure your spot.

$1750: Oct 2020, 4 nights

Late Bird Price – to be paid in full by 2nd October 2020. Deposit of $500 to secure your spot.

Single room (with king bed)	$1795: Oct 2020, 4 nights

Early Bird Special – to be paid in full by 30th June 2020. Deposit of $500 to secure your spot.

$1950: Oct 2020, 4 nights

Late Bird Price – to be paid in full by 2nd October 2020. Deposit of $500 to secure your spot.

**Payment Plans available – please email for details**

How to send back to us: 1) “File” Menu > “Save” 2) “File” Menu > Share > Send Document 3) Add lauren@stmt.com.au to email If you have any problems please let us know! Payment Options:

Direct Deposit:

A/c: Restorative Yoga

A/c: 136321064 BSB: 633-000 Reference: “Retreat & your name” Date of deposit/full payment:

Credit Card:

Name on Card:

Card No.: 1111 2222 3333 4444

Exp Date: 00/00

CVV Code: 000

Please note: Using a credit card will incur a 2% surcharge.

Please save this form once completed and return via email to: lauren@stmt.com.au

Cancellation Policy: Up to 8 weeks before, full refund minus 10% admin fee. From 7 to 3 weeks before, 50% refund. From 3 to 1 week before, 25% refund. 1 week (or less) before, there is no refund. However, I will only implement this policy if I cannot fill the spot.

Agreement:

I, (Enter your name here), understand that the instructions given throughout the classes/retreat are only intended as guidance. It is therefore my responsibility to:

1) Adjust my practice according to my limitations to ensure no personal injury occurs.

2) Inform the teacher before classes of any recent change to my physical, emotional or mental condition.

I hereby declare that I release Stillness Through Movement of any responsibility for any injury sustained and that I will take full responsibility for myself during classes, workshops and activities.

SIGNED: Enter your name here DATE:

Thank-you for your registration. We look forward to sharing this beautiful retreat with you!

Tracy Whitton & The STM Team

info@stmt.com.au 0413 940 532