Get ready for a trip of a lifetime!

Please fill out the following form to register for Wellness in Wilderness.
In May we will have a get together to meet each other and go over details and questions.
Booking your retreat:
Fill out the form below
$2,500 reserves your spot
Reservation confirmed upon receipt of payment
Early bird balance due by February 15, 2020
Full price balance due by March 15, 2020

Name *
Name
As your name appears on your passport. Add Middle into First Name line as needed
Date of birth
Date of birth
Cell Phone *
Cell Phone
Is it OK to text you at this number?
Address *
Address
Payment option *
Please indicate check or Paypal (+3% service fee), and also if you are paying deposit of $2,500 per person, or paying in full.
Please indicate how you first heard about Wellness in Wilderness *
Anything else you'd like for us to know?
Liability
I am in good health and feel confident in my ability to participate safely in this trip. I agree to assume all risks associated with the trip and agree that no liability be attached to Samira Shuruk/Karen Best or Rimmi Sing for any personal injury, illness, delay, loss or damages to property or health. Every measure will be made to keep our program according to the careful research already done. Sometimes things happen, though. Retreat leaders reserve the right to change the program schedule if necessary and shall not be held liable or responsible for any expenses, including but not limited to lodging, meals and transportation incurred by delays or other uncontrollable issues outside of our program.
Model release
I give Rimmi Singh and Karen Best/Samira Shuruk the right and permission to use, reuse and publish pictures of me. I declare that I am at least 19 years of age and the subject of this release, or am the legal guardian of the subject and give my consent. I understand that said photographs will only be used to promote yoga/Pilates on yoga/Pilates and retreat promotional pieces on the web, social media or on marketing materials.
I agree *
I agree to the terms and conditions above, and to the cancellation policy linked in the button below this form
THANK YOU!
We are going to have an amazing adventure together!