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Radiance Yoga Wellness Retreats
with Jessie Chapman & facilitators
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New Zealand Retreat Registration Form
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Which New Zealand Retreat date are you registering for?
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December 1st - 6th 2024 > New Zealand Yoga Hike Restore Retreat
March 16th - 20th 2025 > New Zealand Yoga Hike Restore Retreat
March 23rd - 28th 2025 > New Zealand Yoga Hike Restore Retreat
Name
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Have you been on a Radiance Retreat before? If yes, whereabouts?
What room type would you like to stay in?
Quad Share Bunk Room + shared bathroom
Triple Share Bunk Room + shared bathroom
Twin Room (1 set of bunks each) + shared bathroom
Twin Room (1 king, 1 single) + shared bathroom
Couple's Room + shared bathroom
Single Room + shared bathroom
Couple’s Room + own bathroom
Single Cabin + own bathroom + jacuzzi
Couple's Cabin + own bathroom + jacuzzi
If selecting Twin Share enter the person you're sharing with or type 'Choose for me'
Country & state/region where you live
Your contact number
Age or year of birth
Gender
Occupation (optional)
An emergency contact name & number
Do you have any injuries, physical conditions, illness, allergies or medical conditions we need to be aware of?
Meals: Do you have any food allergies, food intolerances or other dietary requests?
Yoga: Are you new to yoga? Have a regular practice? If so, what style of yoga do you practice, etc (if known). Let us know more here
We'd love to know your reason/s for joining the retreat; what you'd like to experience / get out of the retreat
Is there anything else you feel we should know about?
Where did you find out about us? Please tick below or fill in the 'other' section:
Word of Mouth / Friend
Jessie's Yoga Books
Radiance Yoga DVDs
Internet Search
Radiance Facebook, Instagram, YouTube Channel
Other (let us know in the box below)
Other / how you found out about the retreat
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