Name(s) in full: ___

Name you are usually called by: ___

Address: ___

City: __    State or province: ___   Country: ___

Zip or pin code: ___

Phone:

Mobile___     Landline ___

E-mail address ___

I (we) plan to take the following meals at the retreats:

Kriya Yoga Retreat

___Friday, 29 February lunch
___Saturday, 1 March lunch
___Saturday, 1 March dinner
___Sunday, 2 March lunch

Mahasamadhi Retreat

___Friday, 7 March dinner
___Saturday, 8 March lunch
___Sunday, 9 March lunch