Retreat Registration

Welcome, thank you for saying YES to celebrating Megan's Birthday with her by taking time to enjoy the outdoors, yoga, a sunset trail ride, dinner and bonfire!

September 16th
4 - 9 pm
SOLD OUT

Location:
Millbrook Trailrides
8078 Whitfield Road
Newark IL

Please complete all of the following information fully. Return this Registration Agreement, together with your payment to Aviana. By completing and submitting all attached documentation as required, you, the participant, represent that all information is true and complete, and that you agree to be bound by all of the conditions established by Aviana for this retreat.

An email will be sent out to the group as the time gets closer to help you prepare for the event. Please note, this event is weather dependent, in the event that we need to cancel due to inclement weather, an alternate date can be selected to reschedule before the end of October.

Retreat Registration

* Indicates required field

Name *

First

Last

Phone Number *

Email *

Date of Birth *

Weight *

Height *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency Contact

Name *

First

Last

Phone Number *

Condition of Health

Please list any and all health conditions (mental, physical, emotional) that may effect your participation in this retreat. If there are none to list, please write 'none': *

Are you currently being medically treated for any of these conditions? (If not applicable, please write n/a) *

Please describe any physical injuries or recent surgeries: *

Any dietary restrictions or allergies? *

Submit

- Please Click Submit Button Above Before Proceeding to Payment -

Payment Options

Once you have submitted your registration information, please click below on one of the following payment options to complete your registration, or to avoid the credit card fees (4%), you may submit your payment of $180 via Zelle to avianayoga@gmail.com OR friends and family Venmo to aviana_yoga.

Payment

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