registration form

Annual Radhastami Women's Retreat 2017

Legal name *
Legal name
Date of birth *
Date of birth
Emergency Contact Name *
Emergency Contact Name
Please outline any dietary requirements: *
If unknown please contact us asap with details.
If unknown please contact us asap with details.
If unknown please contact us asap with details.
If unknown please contact us asap with details.
Release - I hereby give permission to Govinda Valley to post photos on their website, local media or advertising materials. I also hereby give permission for my remembrances and comments to be recorded: *