REGISTRATION FORM - YOGA SAFARI | Adventure Out Loud

Registration form - Yoga Safari

If you are human, leave this field blank.

Select a date

Yoga experience

Gender*

Personal details (as per passport)*

First Name

Last*

Last Name

Preferred*

Nickname

Passport number*

Passport number

Nationality*

Nationality

Place of birth*

Place of birth

Issue date*

Issue date (dd/mm/yyyy)

Expiry date*

Expiry date (dd/mm/yyyy)

Date of birth*

Date of birth (dd/mm/yyyy)

Phone*

Phone

Email*

Address*

Street

Suburb*

Suburb

State*

State

Country*

Country

Postcode*

Postcode

Allergies, medical conditions or special requirements*

Please advise us if you would like us to call you to discuss.

Emergency Contact*

First Name

Emergency Contact*

Last Name

Phone*

Phone

Email*

Shirt size*

Complimentary yoga or travel shirt.

How did you hear about us*

If yoga studio, which one?

Name or promo code

Flights*

Travel insurance*

Single supplement*

Accommodation is twin share. Single rooms/tents are available upon request at an additional charge of $500pp.

Sponsor a disadvantaged student through school*

Yes

Sponsorship is not mandatory but it is recommended. Not only will you be empowering a young Kenyan student by keeping them in school, you will also be enhancing your travel experience. Sponsorship is A$1,000/year, 100% goes to our partner charity and you can fundraise if you prefer.

Payment options*

Deposit only

Full fee

Upon receipt of your registration form, we will send you an invoice that includes payment options and directions for payment. Minimum deposit is 10% of total fee.

I acknowledge that the information supplied on this registration form was supplied by me, is true and accurate and if under 18 years was provided in the presence of and with the approval of my parent/guardian. By paying my adventure deposit, I acknowledge that I have read Adventure Out Loud's Terms & Conditions and that I agree to be bound by these terms and conditions.*

Agree

Disagree (please contact me to discuss)

Our Terms & Conditions can be found below.

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Registration form - Yoga Safari

Terms & Conditions

Mandatory Medical Form

KEN-YA YOGA?

SAFARI NINJA

EAST AFRICA FOR A CAUSE

KILIMANJARO FOR A CAUSE

REGISTRATION FORM – YOGA SAFARI

Registration form - Yoga Safari

Terms & Conditions

Mandatory Medical Form

KEN-YA YOGA?

SAFARI NINJA

EAST AFRICA FOR A CAUSE

KILIMANJARO FOR A CAUSE