kauai retreat registration form 2015

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registration form AIVS Kauai Yoga Shakti Program

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  • With Dr. David Frawley & Yogini Shambhavi

    This is page 1 of a 3-page Registration Form.

    Please ll in all pages and email to:

    [email protected]

    or mail to

    American Institute of Vedic Studies,

    PO Box 8357, Santa Fe NM 87504-8357 USA

    _______YES! Register me for the following: (One form per registrant, please)

    Study Program is from 2015 Dec. 28 at 2:00 Pm 2016 January 1 at 6:00 Pm (5 Days)

    Jan. 1, 6:00 Pm Jan 4, 2:00 Pm you will be free to tour the island.

    Cost of Program -USD 2495.00 for 7 nights

    Early Registration discount up to September 1, 2015 USD 2250.00

    A non-refundable deposit of USD 750.00, is payable immediately to book your space.

    Remaining balance is payable by November 30, 2015.

    Optional Na Pali Coast Cruise: 150 USD payable at site.

    PROGRAM/ RETREAT PRICE INCLUDES:

    Retreat: 2015 December 28 2016 January 1 at 6:00 Pm - 10:30 Brunch, afternoon Tea and Dinner.

    January 2 4, 2016 at 2:00 Pm - only accommodation is given. Meals and sightseeing will be at your

    own expense. Kitchen facilities can be used for preparing your personal meals. Accommodation is on

    twin sharing basis.

    Tour of the Hinduism Today Monastery on the Island of Kauai.

    You are strongly advised to make your International ight bookings to the Island of Kauai as soon

    as possible, as cheaper tickets tend to get sold nearer to the date of travel. The airport to arrive at in

    Kauai is LIHUE. Please advise us your Flight Information as soon as the tickets have been booked.

    TRAVEL INSURANCE

    Cancellation Insurance is strongly recommended as no exceptions to the cancellation provisions can

    be made. Please understand that any nancial loss or emergency medical expense will be assumed by

    you. Please read the terms and conditions and fully understand the cancellation penalties.

    RETREAT CANCELLATIONS

    The following cancellation charges as a percentage of total price apply subject to a minimum

    cancellation amount of $750.00:

    Before 90 days $750

    6090 days or more before departure 50%

    30-60 days before departure 75%

    0-30 days before departure/No Shows 100%

    __________ I have read and understood the cancellation and travel insurance clauses

    Yoga Shakti Program in KauaiA M E R I C A N I N S T I T U T E O F V E D I C S T U D I E S

    R E G I S T R A T I O N F O R M

    PH

    OT

    O

    2015, Dec. 28 - 4 January 2016 (7 Nights)

  • This is page 2 of a 3-page Registration Form and Your Photograph.

    First Name (as in passport):

    _______________________________________________________________________________

    Last Name:

    _______________________________________________________________________________

    Occupation:

    _______________________________________________________________________________

    __

    Birth Data:____Month____Day______Year______Time________ Place _________________

    Address:

    _______________________________________________________________________________

    _______________________________________________________________________________

    City: ____________State: _____________Zip: ___________Country: ____________________

    Day Ph: __________________________ Eve Ph: _____________________________________

    Email:

    _______________________________________________________________________________

    Sex: ______________Citizenship: _________________________________________________

    If sharing a room, I want to share with:

    _______________________________________________________________________________

    Contact Person in case of emergency

    _______________________________________________________________________________

    _______________________________________________________________________________

    Any Special Requirements

    _______________________________________________________________________________

    Would you like a Personal Vedic Consultation with Yogini Shambhavi? (Cost 150

    USD): ___________

    Have you been to Kauai before _________________________________________________

    Have You Attended any of our Programs Before? Please specify

    _______________________________________________________________________________

    Signed and Dated ____________________________________________________________

    With Dr. David Frawley & Yogini Shambhavi

    Yoga Shakti Program in KauaiA M E R I C A N I N S T I T U T E O F V E D I C S T U D I E S

    R E G I S T R A T I O N F O R M

    2015, Dec. 28 - 4 January 2016 (7 Nights)

  • This is page 3 of a 3-page Registration Form.

    PAYMENTS

    Check or Money Order Payments

    Enclosed is my Check or Money Order for $

    ___________________________________________

    Make payable and mail to:

    American Institute of Vedic Studies

    PO Box 8357, Santa Fe NM 87504-8357 USA

    Bank Wire Transfers: Please contact us by email and we will provide you our bank

    information.

    Paypal Tranfers: You can transfer your payment to American Institute of Vedic Studies

    at or contact us for more [email protected]

    CREDIT CARD PAYMENTS

    BY PHONE

    Please call in your credit card information to the American Institute of Vedic Studies

    (505-983-9385), credit card type, number, expiration and security code. You can leave the

    information on our voice mail if no one is in to answer the phone.

    Also email us your billing address for the card.

    BY MAIL Please verify your registration before sending in mail payments

    Please furnish your credit card information and sign:

    Please charge my Visa / Mastercard / American Express credit card (circle one) for the

    Amount of US$____________________.

    Credit Card Number:__________________________________________________________

    Expiration Date:____________________Security Code:_____________________________

    Billing address if different than address already given:

    ______________________________________________________________________________

    City: ___________________State: ______________ Zip: _________ Country: ________

    Signed: ___________________________________________ Date: ____________________

    With Dr. David Frawley & Yogini Shambhavi

    Yoga Shakti Program in KauaiA M E R I C A N I N S T I T U T E O F V E D I C S T U D I E S

    R E G I S T R A T I O N F O R M

    2015, Dec. 28 - 4 January 2016 (7 Nights)