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italy Retreat Application

Please complete the form below to being the reservation process. A $1,000 deposit is due to finalize your reservation.

First Name

Last Name

Date of Birth - mm/dd/yyyy

Phone Number

Emergency Contact Name

Emergency Contact Email

Emergency Contact Phone Number

Preferred Room Selection

Single Double No Preference

Are you traveling with a guest?

Yes No

If yes, please provide the name of who you are traveling with

List below any allergies (meditations, food, etc.)

Please list any medical conditions we should be aware of

Please select desired payment option (Deposit = $1,000)

Pay in full Deposit + 2 payments of $1,200 Deposit + 4 payments of $625

Application Agreements

I understand that I am required to have a current passport that is valid through the date of travel

PLEASE READ: By clicking this box, you acknowledge that your deposit of $1000 is non-transferable and non-refundable. You are aware that it is your responsibility to clearly communicate any need for a financial payment plan and understand that all payments must be made on time and paid in full prior to departure for the destination. Should a payment be declined you will be charged an additional $25 fee.

Once submitted and your request for a reservation is reviewed, a member of the Evolution Power Yoga team will contact you with further details and instructions.

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italy Retreat Application

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