Registration form - Anahata Center

First name

Last name

Date of birth

Address

Postal code

Recidence

Phone number

I hereby sign up for the following retreat/training:

Fire & Ice Experience for men

09 February 2025

Quart - Girona

€145

The reason I want to participate is:

I have the following dietary requirements (we eat vegetarian):

I have come into contact with Anahata center via:

Name and phone number of the person we can call in case of emergency:

If you're not going to attent to a retreat you can skipp the next question about the your stay at our retreat center.

Options for your stay:
Stay in a shared dorm (no extra charge)Stay in a shared 2-person bedroom (additional price €100)Private use of a 2-person bedroom (additional cost €250)

Ultimatly, please fill out the next questions:

I declare that I have no mental or psychic illnessI agree that my email address and telephone number will be shared with the other participants of the retreat I am registering forI agree that my data will be stored for billing and information purposesI agree to the terms and conditions and I am aware of the cancellation policy

Room for additional comment:

Down-payment:

Choose a pay method

Choose your bank

I declare that I have completed the above information truthfully.