Conference Registration Form with Payment

RESTORE YOUR INNER GLOW BEACH RETREAT

PLEASE RESERVE YOUR ROOM BY THOROUGHLY FILLING OUT THE BELOW FORM. A $350 NONREFUNDABLE DEPOSIT IS REQUIRED TO HOLD YOUR RESERVATION. Once you fill out all required information an INVOICE will be emailed. (be sure to add rose@rosebruceyoga.com to your contacts). **If you have several people in your party and require separate invoices, please supply those additional names and emails below.** CHECKS OR CASH ARE ENCOURAGED but for your convenience you have the option to pay via debit or credit. ***NOTE: There will be a 3% MARKUP FEE for credit/debit card payments***
Full Name *

First Name Last Name
Phone Number *
E-mail *

Confirmation Email example@example.com
Number of people attending including yourself. PLEASE INCLUDE all participant emails if separate invoices are needed. *
NAME OF ADDITIONAL PERSON 1
E-mail additional 1
example@example.com
NAME OF ADDITIONAL PERSON 2
E-mail additional 2
example@example.com
NAME OF ADDITIONAL PERSON 3
E-mail additional 3
example@example.com

Address

PLEASE NOTE ANY FOOD ALLERGIES OR DIETARY REQUIREMENTS HERE FOR EACH PARTICIPANT
PLEASE SELECT ROOM & OCCUPANCY ~ AN INVOICE WILL BE FORWARDED TO YOUR EMAIL(s). *

4TH FLOOR DOUBLE BED MAIN SUITE SINGLE OCCUPANCY $2500 DOUBLE OCCUPANCY $2200 pp TRIPLE OCCUPANCY $2000 pp QUADRUPLE OCCUPANCY $1800 pp _______________________________________________________________________ 4TH FLOOR DOUBLE BED SHARED SUITE ~ ALCOVE SINGLE OCCUPANCY $2000 DOUBLE OCCUPANCY $1700 pp _______________________________________________________________________ 3RD FLOOR MASTER KING SUITE ~ OCEAN FRONT SINGLE OCCUPANCY $2400 DOUBLE OCCUPANCY $2100 pp TRIPLE OCCUPANCY $1900 pp _______________________________________________________________________ 3RD FLOOR QUEEN ~ OCEAN FRONT SINGLE OCCUPANCY $2200 DOUBLE OCCUPANCY $1900 pp TRIPLE OCCUPANCY $1700 pp _______________________________________________________________________ GROUND LEVEL QUEEN BED PRIVATE ROOM SINGLE OCCUPANCY $1700 DOUBLE OCCUPANCY $1400 pp _______________________________________________________________________ 2ND FLOOR QUEEN WALLBED/LIVING ROOM/ NOT PRIVATE SINGLE OCCUPANCY $1500
QUESTION(s)?
CHOOSE A SIZE FOR YOUR SOUVENIR YOGA TOP *

SMALL MEDIUM LARGE X LARGE
I WOULD LIKE TO PAY BY *

CHECK CASH DEBIT/CREDIT CARD
Enter the message as it's shown *
Should be Empty:

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RESTORE YOUR INNER GLOW BEACH RETREAT