50HR Women’s SelfCare Application Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone (please include country code) *Name you wish to print on your certificate *Date of Birth DD/MM/YY *Passport Number *Nationality on Passport *If you are currently outside of your country of birth, please share where and what has brought you there. *Emergency Contact Name *Relationship *Email *Phone (please include country code) *How did you first hear about High Vibe Yoga? *If refferred, by whom? *Is this your first training or retreat experience?* *YesNo What interests you about the offerings in our 50 Hour Women's Self-Care Training? *Choosing to be part of this Intensive means that you are willing to go very deeply into your process and expansion! There is so much support for this and we know it will be a beautiful time together. Do you have any physical or emotional health conditions that could affect your participation in the training or that we should be aware of? *Do you have any medical conditions that may need attention during the training? Please list any medications you will be taking during the training. *Diet: vegan, vegetarian, gluten free, dairy free, etc. *Please list all food allergies: *Please select your room & rate *Deluxe King (private) $2,260.00 USDSimple Single (private) $2,040.00 USDDeluxe Twin (2 pax, 2 single beds) $1,990.00 USDDeluxe Triple (3 pax, 3 single beds) $1,880.00 USD(SHARE ROOMS) Do you have a preference whom you room with? *CANCELATON & REFUND POLICY *I agree to the following terms: *I understand the $500 Deposit is non-refundable, unless I am not accepted to the courseI understand the final payment balance is due in full by December 15th, 2020I have read and accept the Cancelation / Refund PolicyI will complete the Facebook tasks, prior to the programSubmit