Vermont Wellness and Yoga Retreat

With Lynn Whitlow & Bikram Yoga Pittsfield

REGISTRATION INFORMATION
Retreat Date(s): September 19-23 2012
Name as it appears on passport/drivers Lic. _________________________________________________ E-mail: ______________________ Profession: ________________________________________________ Phone 1 _______________Emergency phone contact name number______________________________ Address: _______________________________________________________________________________ City: _______________________________________ State: ______Zip: ________________________ How did you find out about BYP retreats? ____________________________________________________ What would you like to achieve by attending this retreat? _______________________________________

RATES BELOW INCLUDE: Five days and Four nights of pure yoga and green mountain bliss (Wed

til Sunday morning). Locally sourced, Organic farm fresh meals during your entire stay; starting Wednesday dinner -breakfast Sunday morning; morning brunch options will be fresh fruit and smoothie bar extending into lunch hours. Fresh made juice will be served periodically all weekend, jugs of Crystal springs water (tapped right here in Pittsfield) will be available for you to fill up your water bottles, all meditation sessions, posture clinics, master classes and evening activities included; towels for class will be provided as well as rental mats and refreshments after class, All group activities included, All normally scheduled Bikram Yoga Classes included, Peace of mind, pure health and renewed sense of well being complementary! Onsite parking & showers!! All you need is to show up and we will take care of the rest!!!

All inclusive retreat: $725.00

Lodging Options: * All lodging rates not incl. 9% VT room tax & 18% service charge. If you are a single traveler looking for a share
lodging there are always options. Just ask! The rooms are gorgeous complete with fluffy down comforters, memory foam beds and luxurious Vermont slate showers Heaven! Daily maid service will tend to your room while you are out having fun; All lodgings complete with complementary towels & signature toiletries. *Roll away beds are available for an additional $25.00 rental p/day in those rooms where they are allowed.

The Amee Farm on site. 60.00pp Share or group lodgings (*various rooms available to host groups of 3-4; please ask) 110.00 Full or Queen shared bath (*single/double occupancy; space for roll away available. bath share with 1 other rm) 145.00 Queen Full bath *single/double occupancy 175.00 King Full bath *single/double occupancy The Swiss Farm Inn b&b just next door to Amee Farm 50.00-100.00 *Budget accommodations (private and share) & bunk rooms

Sign up for Massage: $75.00 per 1 hour massage register here: YES!______ # of _______
Massage please * pay on site please bring cash or check!

Retreat total $________________ Lodging total $________________ # of guests in lodgings __________ Payment Information:
*Payment may be by check or credit card. *Payment may be made in full or 50% increments. *Final payment will be due June 1st - at the same time all lodging fees will be processed. *If you need to arrange further payment options please contact me and we will work it out!

Credit Card Info:

Name as it appears on the card:__________________ CC #:____________________________________ Code#________ Exp Date:_____ Billing address & zip:_____________________________

Checks: Please make checks out to: BIKRAM YOGA PITTSFIELD PO Box 872, Pittsfield, VT 05762

**Booking is not final until payment is received**

BYP SEPTEMBER 2012 Retreat LIMITATION OF LIABILITY These paragraphs define our responsibility with respect to BYP retreats and contracted services. Please read carefully. Your signature below represents acceptance of the following terms and conditions. I will not hold Liz Cotter or other instructors assisting in the 2012 BYP Retreat liable for loss or damage to baggage or property or for personal injury or death resulting from acts, omissions, or negligence of any provider of services or accommodations or due to other causes beyond the control of Liz Cotter or other instructors assisting with the retreat, or for loss or additional expenses or inconvenience resulting from acts or omissions of any carrier or any other supplier of services or facilities, or delays, cancellations, re-routings and any other action caused by weather, political disturbances, strikes, lockouts, riots, war, terrorist actions, insurrections or any other reason. Liz Cotter may, in her sole discretion, cancel or change the schedule of all or any part of any program or extension if it considers such action to be in the general interest of participants or their safety, and I waive all claims against the providers arising from such actions or decisions. Liz Cotter reserves the right to substitute guides/instructors and to alter the itinerary when & only if necessary. I undertake the following obligations. To declare any known illnesses or pre-existing health conditions and to seek medical assurance that it is safe to partake in a retreat of this nature; To sign this legal waiver prior to the commencement of services contracted; To accurately and completely furnish any personal information requested by Liz Cotter for the purposes of organizing retreat services; To carefully review all information furnished about the requested retreat; To understand as thoroughly as possible the physical and mental demands of and risks to be encountered during the retreat; To properly equip myself for the retreat; To follow environmental guidelines and regulations while in attendance in accordance with direction from Liz Cotter and BYP staff; To always respect the rights and privacy of other participants. At Liz Cotters discretion a participant may be asked to leave the retreat or may be disallowed from attending specific segments of the retreat if Liz Cotter or part of her staff deems participation to be potentially detrimental to the group or to the individual participant. Cancellation Policy: For cancellations received 30 days or earlier from beginning of the Retreat, we refund all but a 50% non-refundable deposit. There will be no refunds granted for cancellations made 29 days prior or thereafter to retreat start and all charges applicable are to be paid in full to Liz Cotter and BYP. I, the undersigned will not hold Liz Cotter, BYP or her staff responsible for any losses or expenses incurred resulting from cancellation, accident, sickness, stolen or damaged goods, any default of a common carrier (air line, train, bus, etc.) whether it be a result of insolvency, bankruptcy, or another financial difficulty, or resulting from any other travel supplier-related problem. Signature: ___________________________________________________ Date: ________________________________________________________ Please submit this entire Registration form, including the Waiver and payment information, via e-mail info.riversidefarm@gmail.com, by fax 802-746-8567 or let us know it will be arriving hard copy via postal mail to BIKRAM YOGA PITTSFIELD C/O LIZ COTTER, PO Box 872 Pittsfield, VT 05762 so we may reserve your space. See you soon. It is going to be an awesome retreat!