Retreat Date: —Please choose an option—India 21-29 April 2025Bali 7-18 July 2025 Full Name: Preferred name: Email: Phone Number: Gender: —Please choose an option—FemaleMaleNon-binary Date of Birth (DD/MM/YYYY): Current occupation: Nationality / Citizenship: Passport Number: Address: City: ZIP / Postal Code: Country: Facebook / Instagram account name? How did you hear about our yoga retreat? Do you have any food allergies? Do you have any physical limitations/injuries that may prevent you from an extensive asana practice or for sitting for extended periods of time? If yes, please describe: Are you currently taking any form of medication? How long have you been practicing yoga? Please explain experience and styles of yoga explored. What do you hope to get out of this immersion / yoga retreat? Please list the 3 primary things. Please share with us your BIG 'why?'... Why do you want to join our yoga retreat? Is there anything else it would be helpful for us to know about you or your past? (e.g. social therapy, anxiety issues, etc) At Loka Yoga we serve vegetarian food, and we encourage you to explore that diet with us. Y/N? If no, please advise us why? Do you have any specific food requests? Please know that we will do our best to cater for you, but depending on the request, it may not be possible. Have you ever received professional medical treatment due to any psychological condition? EMERGENCY CONTACT - Full name: EMERGENCY CONTACT - Relationship to you: EMERGENCY CONTACT - Email address: EMERGENCY CONTACT - Contact phone number (please include country code): Δ