Pancha Karma Detoxification Therapy

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1 Welcome

2 Accommodations / Pricing

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$5,500.00 – Deluxe Shanti cabin single with Full Treatments

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$4,800.00 – Deluxe Shanti cabin single with basic Treatmens

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$4,200.00 – Siva cabin single with Bath - Full Treatments

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$3,900.00 – Siva Cabin single with Bath - basic treatments

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3 People in your group

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Guest 1		First Name* Last Name* Gender* Male Female Email*

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5 Participant Information

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Spiritual Name
Gender *	Male Female
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Languages Spoken *
Arrival Time *
Departure Time *

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6 Contact Information

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Phone (landline)
Address *
Address 2
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Emergency Contact Info - Name *
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7 Additional Information

Are you pregnant	Pregnant?Due to the nature of the course we cannot accept those who are pregnant
How did you hear about us? *
Have you previously visited the Yoga Farm? *	If yes, please let us know when was the last time
Sivananda TTC Graduate?	yes no
Yoga Experience *	Please describe your experience with yoga and meditation
Occupation *	Please describe your work history
Education	Please describe any formal or informal education experience.
Reasons for attending the course
Medical Issues	Enter "none" if you have no issues
Comments or Special Needs
Special Diet

8 Agreements

Terms and Conditions *	I accept the terms and conditions.All deposits and payments made to Sivananda Ashram Yoga Farm are non-refundable unless canceled within 24 hours of booking. If you need to cancel or reschedule at any time after this initial period we are happy to accommodate you; your payments will be converted to an Ashram credit which you may use for up to twelve months from the time of cancellation for either course tuition or accommodations, or both.
Email newsletter *	Please send me the email newsletter Do not send me the email newsletter

9 Help us make a difference.

$	General Donation This donation goes towards the general functioning of the ashram.

10 Payment

Credit card fee	I agree to cover the costs of processing this registration by paying the credit card fees. We are charged an average of 4% in payment processing fees. By offsetting a portion of these fees, you allow us to direct more of our revenue to offering life-changing programs and maintaining our beautiful property. When this box is checked, we will add 2% to your booking total. Thank you for your support..
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1 Welcome

2 Accommodations / Pricing

3 People in your group

4 Additional Programs

Participants

5 Participant Information

6 Contact Information

7 Additional Information

8 Agreements

9 Help us make a difference.

10 Payment