First Name* Last Name* Email* Enter Email Confirm Email Mobile PhoneAre you currently teaching?* Yes No Please give brief details of the classes you are teaching eg. group general, group therapy or private classes, how regularly etcDo you have a personal practice? Yes No How often do you practice? Please indicate whether you have completed your internship* Yes No Do you have any food allergies or intolerances.* Yes No Please describe food allergies or intolerances you may have:Medical ConditionsPlease provide brief details of any medical (including psychiatric) conditions, allergies and any medications that we should be aware of. If none please enter "None"Is there anything of which we should be aware that may help you or us during the course.Do you have any special requests or suggestions?Please provide the name of a person to contact in the event of an emergency. First Last Emergency Contact PhoneI will make my final payment* Before 10 April 2015 (Early Bird Pricing) After 10 April 2015 My accommodation preference is for* Camping - $ 2,425.00 Non-Ensuite Share Dorm - $ 2,495.00 Twin Share Dorm/Cabin - $ 2,595.00 Single Room - $ 2,695.00 My accommodation preference is for* Camping - $ 2,575.00 Non-Ensuite Share Dorm - $ 2,645.00 Twin Share Dorm/Cabin - $ 2,745.00 Single Room - $ 2,845.00 PLEASE NOTE: Single and twin Shares share an ensuite between two rooms. They may be allocated a single or bunk bed. There are a small number of double beds available for couples by request. Your choice of accommodation cannot be guaranteed as some options are limited. While every effort will be made to satisfy your preferences allocation will be made in order of receipt of applications accompanied by deposit or full payment. No accommodation will be allocated or places in the course reserved until a minimum deposit of $350 or full payment is received.Please provide the name of any person you would like to share with, either as a twin share or the bathroom between rooms First Last Transfers from Ballina Airport NSW to the Venue at Evans Head* I require a one way transfer From Ballina Airport to the venue - $ 30.00 I require a transfer both to and from Ballina and the venue - $ 60.00 I do not require a transfer Book your flights to arrive at Ballina airport between 3 and no later than 4.30PM on 31 May 2015, You may book your return flight to depart from Ballina airport any time after 3PM on 9 June 2015, and from Coolangatta after 5PM. Please let us know your flight details as soon as they are booked. Please ensure you send us your flight details as soon as they are knownI would like to book a personal yoga therapy consultation with Dr NC* Yes No A limited number of consultations will be available during the training. The price for a private consultation is $110 (Non-participants $150). If you wish to have a consultation please ensure you book it now.If you are available to have your consultation with Dr NC on 31 May (between 10 and 4pm) or 9 June (After 1pm) please indicate your eta or etd. It would be extremely helpful if we can complete some of the consultations outside of the course schedule.TotalTerms and Conditions* I have read and agree to the terms and conditions below TERMS AND CONDITIONS 1. REFUND POLICY If a participant withdraws from the program the following terms and conditions apply: a) If the participant withdraws on or before 10 April 2015 the participant will receive a full refund of all monies less a non-refundable administration fee of $350; b) If a participant withdraws after 10 April May 2015 the participant will forfeit 50% of their total cost of the course; c) If a participant withdraws after 17 May 2015, no monies will be refunded. d) However, at any time prior to the course commencement, a withdrawing participant may arrange to transfer his/her payments to another person to attend the same workshop at the same time place in his or her stead. 2. CANCELLATION Yoga Therapy Australia reserves the right to cancel any event, workshop or training if necessary. In the unlikely event that this occurs, a full refund of all monies will be returned to the participant. However, no responsibility will be accepted for any consequential loss in any circumstances, including any travel or accommodation expenses incurred Appropriate TRAVEL INSURANCE is highly recommended where applicable. 3. PHOTOGRAPHS, FEEDBACK etc. By undertaking this course you agree that photographs taken that may include you and feedback given by you, may be used by Yoga Therapy Australia and the presenters of courses for marketing purposes. If you would prefer we did not use any of the material written by you or containing an image you must contact us in writing. 4. DISCLAIMER Yoga Therapy Australia accepts no responsibility for any act, omission, default or neglect of themselves, their employees, agents or associates for any injury, damage, or loss to persons or goods whatsoever or however the same may be caused. To combat spam please answer the following simple maths question.