Himalayan Pilgrimage Registration Form • Kawai Purapura

Saturday, 26th May – Tuesday, 12th June 2018

Personal Details

First Name*

Last Name*

Title*

Address*

City/Town*

Email*

Mobile Phone

Home Phone

Work Phone

Country of Residence*

Occupation*

Emergency Contact Name*

Emergency Contact Telephone Number*

• How did you hear about our pilgrimage?*

Other, please specify

Experience:

What has your practice of yoga, meditation, or similar been?*

How would you describe your fitness level?*

Have you been to India previously? Please provide details.*

Have you been to the Himalayas previously? Please provide details.*

Provide brief details of any medical condition or injuries you have: (Include medications, psychiatric treatment, nervous disorder, etc.)*

ADDITIONAL INFO:

ACCOMODATION & MEALS At the Vedic Yoga Centre, Rishikesh: Twin share with private rooms available at extra cost. Bhojvasa: Marae-style and/or tent accommodation. Tapovan: Marae-style and/or tent accommodation. Gangotri: Twin share (unless otherwise requested). All meals provided are vegetarian.

Any special health or dietary considerations? Please note: this pilgrimage is not advised for pregnant women or those suffering from chronic health problems such as asthma, blood pressure issues, heart ailments or psychological problems.

PAYMENT DETAILS

The following payment has been made via Ticket Tailor*

$NZ 500 Deposit (non-refundable). Must be paid by 24 April 2018.
$NZ 2,000 (Experience Ticket if you have already paid the deposit). Due 10 May 2018.
$NZ 2,500 (Experience Ticket + Deposit). Due 10 May 2018.

Terms and Conditions

Payment Policy:
Deposit of $500.00 and fees paid up until 30 days prior to commencement date are non-refundable

Full payment is due by 10 May 2018 and participants agree to pay any outstanding balance no later than this date.

Disclaimer: This pilgrimage includes trekking to a remote mountainous area, across a glacier without comprehensive medical supplies or facilities. In the event of an accident, illness or injury an evacuation would take at least one day. We acclimatise ourselves in Gangotri, but signs of altitude sickness, such as sleeplessness, coughing, head ache, loss of appetite, nausea, vomiting, and muscle cramps, may occur. Generally, these can be managed with rest, reducing altitude for some time, breathing and/or medicines. A trip of this nature has its share of risks and dangers, especially in respect to the terrain, weather, high altitude and remoteness. Accidents on this trek could cause one to get injured or fall ill. I hereby declare that my participation in this trek is completely voluntary, and I am fully aware of the risks involved. I will not hold Kawai Purapura wholly or partly responsible in case of any accident, illness, injury or death on the pilgrimage.

Presenters We reserve the right to alter the program of this pilgrimage without notice due to unforeseen circumstances. If travelling from out of town, please consider travel insurance. We reserve the right to cancel the course at any time.

Use of Photographic Material: Any photographs taken by Kawai Purapura of attendees during this course may be used by Kawai Purapura for marketing purposes. If you do not wish us to use photos with your image, please advise us to Kawai Purapura Retreat Centre, in writing before the course starts.

By checking this box you agree to the terms and conditions above*

I agree