Pay What You Can – 5 Day Yoga Retreat

Select Language:

Join us for a special Pay What You Can retreat – a nurturing space for healing, connection and accessible yoga for all. 💕

* These fields are required

1 Welcome

Guest 1		First Name* Last Name* Email* Preferred Name This name will appear on your name tag. If left blank, we’ll use your first name by default. Gender*
Guest 1		First Name* Last Name* Email* Preferred Name This name will appear on your name tag. If left blank, we’ll use your first name by default. Gender*

After completing this form, emails will be sent to everyone in your group to complete their information.

Preferred Name	This name will appear on your name tag. If left blank, we’ll use your first name by default.
Birth Date *
Post Code *
Gender *
Phone (Mobile) *
Diet Notes *
Any special health or dietary considerations *
Injuries *	Please provide brief details of any injuries you have. If none please type "None"
Emergency Contact Name *	Please provide the name of a person we can contact in an emergency
Emergency Contact Phone *	Your emergency contact's phone number (please include area code and if outside Australia the country code)
Retreat Terms and Conditions *	I agree to Byron Yoga's Terms and ConditionsI hereby state that the information I have provided in this application is true and correct. I have read and accept the Terms and Conditions

AUD $	Pay What You Can You're welcome to contribute what feels right for you. Whether you're giving more or receiving support, your presence enriches the experience for all. Let’s hold space for healing, compassion and community together. Retreat value: $1390 Suggested contributions to help us cover our costs: Community Price: $395 Recommended Price: $695 Pay-It-Forward Price: $895 No need to justify your choice — we trust you to choose with heart.

Discount Code

Sub Total	$0

Donations	$0

Taxes	$0

Deposit	$0
	$0 next payment date * last payment amount will be $0

Due Now	$0 $0

Choose Payment Option

	Please note that we are unable to process your booking until we have received your deposit. We will hold your place for one week while awaiting confirmation of your payment from our bank. If the deposit is not received within this time, your booking will be cancelled. You have chosen to pay by bank transfer If you choose to pay by direct deposit, either online or over the counter at your banking institution, please be sure to send a copy of your receipt via email to admin@byronyoga.com or via fax to 02 6678 0313, to ensure we can track your payment. Direct Deposit Details Name of Account: Purna Yoga Name of Bank: National Australia Bank, Lismore, NSW BSB: 082-522 Account Number: 85-960-6267 Swift code: NATAAU3303M (For overseas deposits) Please include your name when you arrange the deposit. Click on the button below and these instructions will be repeated on the next page.

Name on Card
Card Number*
Card Expiration*	Month Year
Card Security Code	CVV is a 3 or 4 digit code on the back of the card
Country*