First Name*

Last Name*

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Age*

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Postal Code*

Any Illness -- Present / Past History*

Food allergies, please specify details

Current Medication*

Can You Climb Steep Gradients (Like Hills) :
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Why Would you like to do retreat?*

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PLEASE NOTE THE FOLLOWING:

1. No smoking and no alcohol allowed in or outside premises

2. Mobile phone are not to be brought in the main areas. We advice you use them only in your rooms or preferably not at all

3. Maintain silence

4. This is a retreat, not a holiday