Rolf Gates

Rolf Gates: master yoga teacher & author

Casa Grande Mountain Retreat, Puerto Rico
July 2010 + March 2011

Charlotte Yoga, Charlotte NC
Feb - Oct, 2010

Cross Gates Family Fitness
Slidell, LA
Jan - Oct, 2010

Back Bay Yoga, Boston MA
October 2010-April 2011

Hot House Yoga, Virginia Beach, VA
Feb 2010-June 2011

INSPIRATION + FLOW: A VINYASA/KIRTAN RETREAT:
Esalen Institute, Big Sur CA
Rolf Gates + GIRISH
February 7th-12th, 2010

Thank you for you interest in our Vinyasa/Kirtan Retreat. We look forward to receiving your registration. Namasté

CONTACT INFO

First Name:			Last Name:
Street Address:
City:			State:
Zip Code:			Country:
Daytime Phone:			Evening Phone:
Email:

Company:			Marital Status:
Occupation:			Gender:
Age:

PHYSICAL HEALTH

Under physician's care? Yes No

If yes, for what reason?

Epilepsy? Yes No

Diabetes? Yes No

Are you currently seeking mental health care? Yes No

If yes, for what condition?

Please list any current medications:

Have you ever been hospitalized? Yes No

If yes, for what condition?

Do you have any dietary requirements?

What is your past history with yoga practice?Please include any previous workshops or intensives with Rolf Gates or GIRISH

INTENTION SETTING:
Please take a moment to write down what you want out of this Retreat. There is a power in writing down goals, sharing them and then referring to them often. What is your intention for taking this program?

Is there anything else you would like us to know?

PAYMENT OPTIONS:

	$500 deposit only for bunk room ($1500)

	$500 deposit only for shared double ($1775)

*The schedule of payments will be determined by your selection in your payment plan contract. This will be sent to you upon receipt of your application and payment choice.

Please note that upon acceptance of your registration a $500 non-refundable deposit will be charged.

The remainder of your balance will be charged on January 1st, 2010/or based on the schedule in your payment plan contract.

Contact Mariam Gates with any payment inquiries.

Refund/Non-Refund Policy: $500 is non-refundable upon registration. Cancellations must be made 60 days before the retreat begins. We can not offer any refunds for cancellations within 60 days of the event.

Contact Mariam Gates with any payment inquires, 617-271-7106 (direct line). You may also mail your payment check to:

Gates Yoga
PO BOX 421
Santa Cruz, CA 95060