Escape the World Reservation Form

Please select the retreat of your choice:


Retreat in Ubud scheduled for 2010 on:
January 17 - 22, 2010
June 27 – July 2, 2010
Jan 31 - Feb 05, 2010
July 11 - 16, 2010
February 14 - 19, 2010
July 25 - 30, 2010
February 28 – March 5, 2010
August 15 - 20, 2010
March 14 - 19, 2010 (Fully Booked)
August 29 – September 3, 2010
March 28 - April 5 (festival retreat)
September 12 -17, 2010
April 5 - 10, 2010
September 26 – October 1, 2010
April 11 - 16, 2010
October 24 - 29, 2010
May 2 - 7, 2010
November 14 - 19, 2010
May 16 - 21, 2010
December 5 - 10, 2010
May 30 – June 4, 2010
December 19 - 24, 2010
June 13 -18, 2010
December 26 - 31, 2010


Occupancy

Single Occupancy Twin Share (1 bed) Twin Share (2 beds)

If you are sharing a room, what is the name of your room mate?


Please note: Each participant must fill out this registration form separately.

Personal Information

• First Name
:
*


• Family Name
:
*


• Home Address
:


• Country
:
*


• Home Telephone Number
:
*


• Office Telephone Number
:


• Mobile Phone Number
:


• E-mail address
:
*


• Re-enter your email
   address
:
*


• Arrival Flight Date
:
   


• Arrival Flight Details to Bali
:
Airline :      Flight #


• ETA (estimated time
   arrival)
:


• Departure Flight Date
:
   


• Departure Flight details
   from Bali
:
Airline :      Flight #


• ETD (estimated time
   departure)
:


• Will you stay with us prior
   to the retreat?
:
Yes No


• If yes, date of arrival at
   ONEWORLD retreats -
   Kumara
:
   


• If no, where will you stay
   prior to the retreat?
:


• Telephone number of your
   accommodation prior to the
   retreat? (if apply)
:


• Will you stay with us after
   the retreat?
:
Yes     No


• If yes, date of departure
   from ONEWORLD retreats -
   Kumara
:
   


• If no, where will we take
   you after the retreat?
:


• Have you been to Bali
   before?
:
Yes No


• Your Birthday
:
   


• Yoga Experience
:


• Type of Yoga
:


• Do you practice meditation
   on a regular basis?
:
Yes No


• Have you practiced
   meditation in the past?
:
Yes No


• Are you a vegetarian?
:
Yes No


• Do you have allergies or
   some food you dislike?
:
Yes No


• If yes please enumerate
:


• Please explain if you have
   any physical disorder that
   we should be aware of


:



• Special Request
:


How did you hear about us...?
:

Please  Specify:
(Such as Google, Magazine, Web Link, etc...)


RETREAT PARTICIPANTS DISCLAIMER


I have read and agree to the Consumer Disclosure Notice
      Note: You will be asked to sign the disclaimer upon arrival at the retreat.

We will confirm your reservation within 36 hours.