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Costa Rica 2015, Yoga and Surfing

The Nosara Yoga Institute, Costa Rica
December 12-19, 2015


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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.

Please describe your experience level with surfing:

Is there anything else you would like us to know?


The fee includes accommodations, 3 delicious meals per day, all of the yoga instruction and all of the surfing instruction - including equipment! Pricing is per person for double occupancy. Single rooms are available - please contact us for single room pricing information.

Please Note: If you are choosing 'Payment Plan' you will be charged a $500 deposit now with the remaining amount due on October 1st, 2015.


Executive Private Room
$2550 full pay



Double Deluxe with Private Bath
$2500 full pay



Private Room with Connected Bath
$2400 full pay


Double with Connected Bath
$2250 full pay


Triple with Connected Bath
$1850 Full pay



By checking this box and clicking on the "Submit" button, I agree to pay the amount designated for the payment option selected above. I agree that if my application is accepted, I will immediately be charged the full amount if I have selected the full payment option, or $500 if I have selected a payment plan option. The remainder of the amount due (if I did not pay in full) will be charged in full on October 1st, 2015. (required)

I have read and agree to the Payments/Refunds Terms and Conditions (required)

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

Contact Mariam Gates with any payment inquiries.


I understand and agree that if I cancel my enrollment at least 60 days before the beginning of my program, I will be entitled to a refund of amounts paid, less $500. I understand and agree that if I cancel my enrollment less than 60 days before the beginning of my program, or if I do not complete the program for any reason other than cancellation of the program by Gates Yoga Enterprises, Inc., I will not be entitled to any refund, and will be obligated to pay any remainder of the enrollment fee designated above. If I cancel my enrollment or fail to complete the program, I may request credit toward another program, which may be granted by Gates Yoga Enterprises, Inc. in its sole discretion. This agreement shall be governed by the laws of the State of California without regard to any law that directs the application of the law of another jurisdiction.

Contact Mariam Gates with any payment inquires, (831) 334-3060 (direct line). You may also mail your payment check to:

Gates Yoga
PO BOX 421
Santa Cruz, CA 95060


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