VINYASA YOGA + BIG MIND MEDITATION INTENSIVE
with Teacher + Author Rolf Gates
June 27th-July 4th, 2009 - Pura Vida, Costa Rica

This week is an “intensive” and therefore is intentionally challenging. It is ideal for those in their first couple years of practice as well as more seasoned practitioners. Six months of regular vigorous practice is suggested. For those with less than 6 months experience, we will offer support regarding how to best prepare.

CONTACT INFORMATION

Name:

Street Address:

City: State: Zip Code: Country:

Daytime Phone:

Evening Phone:

E-mail:

Company:

Marital Status:

Occupation:

Gender:

Age:

PHYSICAL HEALTH

Under physician’s care: yes no
If yes, for what reason:

Do you have Epilepsy? yes no

Do you have Diabetes? yes no

Are you currently seeking mental health care? yes no
If yes, for what reasons:

PHYSICAL HEALTH CONTINUED:

Please list any current medications:

Have you ever been hospitalized? yes no

If yes, for what reason:

Do you have any dietary requirements?

What is your past history with yoga practice?

Please list any past workshops or intensives with Rolf Gates:

INTENTION SETTING:
Please take a moment to write down what you want out of this intensive experience. There is a power in writing down goals, sharing them and then referring to them often. It is suggested that you do this practice in preparation for this week. At the very least, please share your goals for this experience with us now so we may better support you during the intensive. You may wish to add an additional page.

ROOMING PREFERENCE (circle one)

The Tentalows: $1450

The Standard Rooms: $1575

The Deluxe Rooms: $1676

The Super Deluxe Rooms: $1780

(All prices are based on double occupancy)

Refund/Non-Refund Policy:
$500 is non-refundable upon registration. Cancellations must be made 30 days before the retreat begins. We can not offer any refunds for cancellations within 30 days of the event.

Contact Mariam Gates with any payment inquiries or any other questions regarding the retreat.

Please mail this registration form with payment to:

Gates Yoga
PO Box 421
Santa Cruz, CA 95060

Namaste!