Farm to Yoga 2016 : Registration Form



Full Name: ____________________         Preferred Name: ____________________


Emergency Contact


Phone number:



1. Please select your accommodation (circle)


  1. Shared Room in Farm house

  2. Private room

*All of our rooms have one double or queen bed. We have one room with a double and single bed which accommodates 3 (first come, first serve). Please clearly indicate who you will be sharing with if you plan for double accommodation. 


2. Bike Riding

As part of our retreat we will be going on a "bike crawl" from the farm site into the town of Pemberton. The bike ride is approximately 10 kilometres each way on a quiet paved road. Participants are required to provide their own bike, it doesn't need to be anything fancy- just something to get you into town at a very leisurely place. If you do not have access to a bike, please let us know with plenty of notice and we will do our best to arrange one for you. 


3. Investment & Payment option (please circle or indicate)


Early Bird

Shared     $380

Single      $470



Shared     $420

Single      $510

*Payment must be made in full by August 19th for early bird pricing. 50% non-refundable deposit required to secure your spot.


4. Previous Yoga Experience (not reqired):




5. Any injuries or illness, past or current?




6. Do you have any allergies or food restrictions (vegetarian, gluten free, vegan, etc)? Our chef is great at accommodating any dietary concerns.




7. What would you like to get out of this weekend?





8. Is there any specific food requests you would like to see on the menu or learn to make?






9.Anything else you would like to tell us about?