NAME *

First Name

Last Name

MOBILE PHONE

(###)

###

####

ADDRESS

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

What type of accommodation are you interested in? *

Please choose one of the following 3 options:

Private Lodge Suite ($1699pp + GST)

Shared Lodge Suite ($1349pp + GST)

Shared Rainforest Cabin ($!749pp + GST)

Will you be sharing with a friend or partner? *

Yes

No

DIETARY RESTRICTIONS *

Please tell check off any items on this list that you avoid:

All Animal Products (i.e. I am vegan)

Red Meat

Poultry

Fish/Seafood

Dairy

Wheat/Gluten

I can eat anything!

YOGA PROPS *

Please tell me what yoga props you are able to bring with you, if any:

Yoga Mat

Bolster

Blocks

Massage Balls

Blanket

Eye Pillow/Sleep Mask

Strap

OPTIONAL ACTIVITIES

Please check any activity you might be interested in participating (for an additional fee):

Surf Lessons

Massage

Acupuncture Treatment

Private Photo Shoot

Kayaking/Paddleboarding

Other: