Costa Rica Pura Vida Retreat

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1 Welcome

2 Choose the dates of your stay

3 Choose Your Retreat Accommodation

4 People in your group

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

5 Enhance Your Retreat Package

6 Participant Info

Phone *
Address
Address 2
City
State/Prov.
Zip/Postal
Country
Email newsletter	Please send me the email newsletter
Comments or Special Needs
Gender
Birth Date
Requested Roommate
Special Diet
Diet Notes	Do you have any allergies to an specific foods. Please name all.
Emergency Contact Info *	Name, Email and Phone
Medical Issues *	Enter "none" if you have no issues
How did you hear about us? *
What is your main intention for going on this retreat?: *
What is your yoga experience? (if applicable): *	New, Beginner, Moderate, Advance. Types of Yoga practiced.

7 Terms and Conditions

8 Security Check

9 Payment

	By submitting payment, you authorise Bella Retreats to send instructions to the financial institution that issued your card to take payments from your card account in accordance with the terms of Bella Retreats's agreement with you.