Block Island Yoga

Welcome !

Please complete this form AND
pay via Paypal (on website) or send check
as soon as possible to hold your space.

You will receive a CONFIRMATION email upon
completion of this form.

Please confirm subscription to register. Thank you !

* indicates required

Email Address *

First Name

Last Name

Address

Street Address Address Line 2 City State/Prov/Region Postal/Zip Country

Phone Number

Food Allergies

Emergency Contact

Payment *

Mail ( Block Island Yoga, 51 Reed St Warwick RI 02886)
Paypal ( Return to Website and click ADD TO CART button)

Props

I can bring my own yoga mat
I can bring my own meditation cushion
I can bring my own blanket/throw

Agreement

I understand a $35 fee will be withheld if I cancel within 1 week of retreat.