Registration Form

Please register me (us) for the Iyengar yoga retreat in Ireland with Kevin Gardiner

May 26-June 2, 2012

The workshop cost per participant is $2300 (or $2400 if reserved after January 10, 2011). The registration fee is $350 per participant with the full amount due on or before March 15, 2012. Please make your check or money order payable to “Late Wisdom” and mail it with the completed booking form below to:

                                                                Late Wisdom
                                                       P.O. Box 551
                                                Flossmoor, IL 60422, USA

NAME(S) _________________________________________________________________

ADDRESS _________________________________________________________________

CITY ____________________________ STATE ______________ ZIP _______________

HOME PHONE _______________________ OFFICE PHONE _____________________

E-MAIL __________________________________________________________________

I (we) have enclosed $___________ which is payment-in-full.

I (we) have enclosed the registration fee of $350 per participant

for a total of $___________with the balance due on or before March 15, 2011

Note: Refunds prior to April 1, 2011 will incur a $200 cancellation fee per participant.

After that refunds will be made only if a replacement can be found. In the event the

workshop is cancelled a full refund will be given.

I wish to share a room with ___________________________________________________.

(If not marked it will be assumed that you want single accommodations)

I (we) have studied _____________________________________ yoga for _____ years with

__________________________________________(primary yoga instructor).

My (our) dietary concerns are: _________________________________________________

________________________________________________________________________

It is okay/not okay (select one) to release my (our) name(s) and e-mail address to other fellow

participants on this trip so we might coordinate travel arrangements.

I (we) have read and understand the information contained within the "Late Wisdom" web-site

relating to this retreat.

Signed: _________________________________________________ Date: ___________

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