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 referred, by whom? *Is this your first training or retreat experience?* *YesNo What interests you about this immersion? *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: *I agree to the following terms: *I understand payments are non-refundable, unless the course is canceled by High Vibe Yoga or the Yoga Barn.Refunds will be made in full less 15% administrative fee in the case of cancelation by the hosts.Submit