Ayurveda Retreat

2019 Ayurveda Retreat Dates

$1001 USD

Submit An Online Application Form OR Download, Print, Scan & Email The PDF Form Below

Wait For Your Acceptance Email & Payment Information

Receive Your Payment Confirmation Email Along With Detailed Instructions To Help You Prepare For The Retreat

Refunds will be issued before December 15, 2019, minus a $50 admin fee (+ online transaction fees)

Please complete a separate form for each applicant.
A small jpg, gif, png or pdf photo file of the applicant will also need to be uploaded through this online form.
After successfully submitting this application form you will be notified by email if you have been accepted.

Please fill out the application form below for the Ayurveda Retreat.

Name*
First Last
Email*
Ayurveda Retreats
I am applying for these ayurveda retreat dates:*
- Dec. 25-30, 2019
Includes course fees, materials, room and board
Total
$0.00
Upon receiving confirmation of my acceptance to attend the retreat, I will be contacted with further details on how to make payment.*
- I understand the above. I also understand that my acceptance can be revoked should I decline to make any payment.

Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Age:*
Gender:*
- Male
- Female
Please Upload a Photo of Yourself*
Photo needs to be a passport size head-shot image of just yourself.
Please do not include others in the photo.

(acceptable file formats: jpg, gif, png, pdf)

All applicants must sign below to register: I understand that I am attending the the Ayurveda program of my own free will and by signing this form I hereby release SMVA Trust and Manidweepa Maha Samsthanam Trust from any liability from injury, loss or damages during the Ayurveda Retreat, while traveling to and from the Penusila Ashram, and whenever staying as a guest at the Penusila Ashram. I am aware that a refund will not be given for any cancellations occurring after December 15, 2019. All refunds will be subject to a processing fee of $50.
I agree to all the terms and conditions outlined above:*
- Yes
Typed Signature:*
Date:*
Name
This field is for validation purposes and should be left unchanged.