Day Visit

* These fields are required

1 Welcome

2 Price

3 People in your group

Guest 1		First Name* Last Name* Email* Gender*
Guest 1		First Name* Last Name* Email* Gender*

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

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4 Participant Info

What information about your pronouns would you like on your badge? *
Spiritual/Preferred Name
Cell Phone (Primary) *	Please format phone #'s as xxx-xxx-xxxx
Home Phone	eg. xxx-xxx-xxxx
Address *
Address 2
City *
State/Prov. *
Zip/Postal *
Country *
Date of Birth *
Gender *
Badges:	As part of our health protocols (read more), we're asking all volunteers, guests, program participants, etc. to wear name badges while at the Ashram. Please answer a few questions to help us prepare your badge.
How would you like your name to appear on your badge? *
Pronouns: *
First Time? *	Yes No Is this your first visit to Yogaville?
What inspires your visit to Yogaville?
Preferred Day Visit Date *
My Dates are Flexible	Yes
Please give us some alternative dates or time spans (month/year) that would work for you.	Thank you for your flexibility, we are happy to work with you to find the best time for your Group/Retreat to come and enjoy your time here with us.
Hatha Yoga Level *
Meditation Level *
Do you already or would you like to receive the Yogaville Program Guide and Program Brochures?? *	Yes No At this time due to COVID we have discontinued the Program Guide and all print media sent in the mail. We are hoping to start again in 2023. If you'd like to receive print media in the mail to your address please check yes.
Email newsletter	Do you already or would you like to be sent our email newsletter?You'll receive our weekly newsletter with information about Yogaville happenings and upcoming programs!
Health Concerns or Physical Limitations?	Anything that may be useful in giving you the best service possible. Please list any serious allergies or physical limitations.
How did you hear about this program? *
If Other, please let us know how.	Please let us know in what other way you heard about this program
Personal Comments	Please Contact ARC Directly with any changes to your Reservation. 800.858.9642
Emergency Contact Name	First, Last
Emergency Contact Phone	xxx-xxx-xxxx

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First Name
Last Name
Card Number *
Card Expiration *	Month Year
Card Security Code	usually a 3 digit code on back of card

<-- Return To Program Page

1 Welcome

2 Price

3 People in your group

4 Participant Info

5 Agreements

6 Help us make a difference

7 Payment