* February 20 – 27th, 2010 * Costa Rica *
Ashtanga Yoga Retreat with Joanne & Mark DARBY Registration & Agreement Form

First Name: Date of Birth: Address: Postal/ Zip code: Telephone: Days: Cell:

Last Name:

City: Country: Evening: E-mail:

Specific physical or medical conditions/ injuries: Other health information: Food allergies/ dietary restrictions: Please give us information about your yoga practice (When did you start? Do you practice regularly?):

Name of Emergency Contact: Telephone of Emergency Contact: Days: Name of Second Emergency Contact: Telephone of Second Emergency Contact: Days: Evenings: 1 Evenings:

Sattva Yoga Shala, 1455, St- Mathieu - Montréal, Qc H3H 3M4 - Canada

▪ Retreat fees per person (please check the option of your choice): Nr of rooms available 2 DESCRIPTION PRICE* PRICE Your Choice

per yogi
Small rooms with two single beds Intended for 2 people Small rooms with one double bed Intended for 1 person Big rooms, private bath, one double & two single beds Intended for 3 people Bungalows, private bath, hammock, one double and one single bed Intended for 2 people Single occupancy in one of the Bungalows US $ 1050

Per non- yogi
US $ 600


US $ 1150

US $ 700

US $ 1095

US $ 645



US $ 1250

US $ 800

US $ 1600

US $ 1150

*The prices include: - Yoga (except for “non- yogi” fees): Daily morning Ashtanga Yoga led- classes & daily meditation, 4 afternoon workshops (restorative or posture analysis), as well as discussion or meditation in the evenings, - Accommodations: Room or private bungalow according to your choice at Hotel Los Mangos in Montezuma, - Meals: 2 meals a day. Breakfast will be served in a vegetarian restaurant, Organico, and dinner will be provided in the renowned restaurant Playa de Los Artistas. ▪ Reservation & Payment (Note: Payment is due in US dollars) TAXES ARE INCLUDED - A US$ 300 non- refundable deposit per person will secure your place at the moment of inscription, with the full balance due January the 7th, 2010, - Fees are payable by Interac & visa/mastercard at the studio or per telephone, by check (payable to Sattva Yoga Shala) or by bank draft.

Note: Payment in Canadian dollars is possible. Prices will then be calculated according to the current US$ - CAD$ exchange rate applying - Currency converter:
Reservation and placement in Hotel Los Mangos is on a first come first serve basis..
Sattva Yoga Shala, 1455, St- Mathieu - Montréal, Qc H3H 3M4 - Canada


be sure to submit your request asap!
▪ Please note: - Round-trip airfare from city of departure to San- José (Costa Rica), bus Montezuma, tips, gratuities and excursions are not included in the prices, - There are cancellations fees: - Until December 20th, 2009 (60 days before start date) - Until January 20th 2010 (30 days before start date) - Until February 13st, 2010 (7 days before start date)

or flight from San José to

$400 cancellation fee $600 cancellation fee 100% of trip price

AGREEMENT I certify that the above information is true and complete, to the best of my knowledge. I fully understand that I am solely responsible for my health, safety and well- being while participating in all the retreat activities. I agree that I will inform the instructors of any injury. I understand that there are risks associated with any physical exercises and I agree to hold the instructors and Los Mangos Hotel harmless from all responsibility for any injury or health problems that may arise during the retreat period of time.

Enclosed is a check in the amount of: Payment in full Deposit



Note: Check should be made payable to Sattva Yoga Shala



Please carefully fill in all required information above and mail the application form with your registration fees/ deposit to: Sattva Yoga Shala 1455, St- Mathieu Montréal, Qc H3H 3M4 Canada

Sattva Yoga Shala, 1455, St- Mathieu - Montréal, Qc H3H 3M4 - Canada


Got questions? Please E- mail:


Sattva Yoga Shala, 1455, St- Mathieu - Montréal, Qc H3H 3M4 - Canada


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