Name *

AS WRITTEN ON YOUR PASSPORT

Email Address *

Passport Number *

Passport Expiration Date

Flight Number *

Airline *

Date of Flight

Flight Arrival Time

Level of Yoga *

Beginner (attended less than 5 classes)

Intermediate

Advanced (attended more than 100 classes)

Dietary Preference

Please select all that apply.

Paleo

Vegan

Vegetarian

Ovo-Vegetarian (consumes eggs)

Ovo-Lacto-Vegetarian (Consumes eggs and milk)

Pescetarian

Gluten-Free

Yeast-Free

Dairy-Free

No preferences

Food Allergies or Sensitivities

Please list all food allergies or sensitivities if applicable.

Medical Conditions

Please list (and describe where necessary) any medical conditions you have.

Emergency Contact Name *

Must be an individual who is NOT attending the retreat.

Questions & Concerns

Do you have any specific questions or concerns regarding your travel to Panama?