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Registration for Spiral into Stillness Retreat
  2. Personal Information
  3. First Name(*)
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  4. Last Name(*)
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  5. Sex(*)


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  6. Birthdate (dd/mm/yyyy)(*)
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  7. Street Address(*)
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  8. Apt. No.
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  9. City(*)
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  10. Province or State(*)
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  11. Postal or Zip Code(*)
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  12. Country(*)
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  13. Work Phone
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  14. Mobile
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  15. Home Phone
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  16. Email
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  17. Emergency Contact Information
  18. First Name(*)
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  19. Last Name(*)
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  20. City(*)
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  21. Province or State(*)
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  22. Relationship(*)
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  23. Phone Numbers(*)
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  24. Email
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  26. How would you describe your level of ability in yoga?(*)



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  29. Do you have any medical conditions that you feel we should know about?
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  31. Do you have any physical injuries that you think we should be aware of?
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  33. Can you tell us briefly what inspires you to participate in a yoga retreat?
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  35. How did you find Spiral Yoga Retreats?




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  38. Emergencies and Health Issues: Villa Sumaya is in no way responsible for participant’s health during their stay at our retreat center. In the event of an emergency we will assist clients to the fullest means possible, but assume no responsibility for outcomes.
  39. Theft: Villa Sumaya assumes no responsibility for theft or loss of valuables in rooms or on hotel grounds. We have an office safe available for valuables.
  40. Grounds and Facilities: Villa Sumaya agrees to maintain the rooms, temple and grounds in working order. In the event of a malfunction our maintenance team will respond to the issue in a timely manner.
  41. Media, Copyright and Liability Agreement: As a participant, I agree that any photos or videos produced by Spiral Yoga from this retreat may be distributed without limitation through any means, and I shall not receive any compensation for my participation. I confirm that any and all such material furnished by me for this program is either my own or otherwise authorized for such use without obligation to any third party or me. I also agree to the use of my name, likeness, portrait or pictures, voice and biographical material about me for education and organizational promotional purposes. I further agree that my participation in the program confers upon me no rights to use, ownership or copyright. I release Spiral Yoga, Rebekka Valian and Karen Keresturi, its agents, and assigns from all liability which may arise from any and/or all claims by me or any third party in connection with my participation in the programs.
  42. I agree to the terms of service(*)

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  45. Accomodations and Payment
  47. $500 non-refundable, non-transferable deposit due with registration by Jan 15, 2012.
  49. Double Room


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  52. Single Room


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  54. Roommate Request
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  55. Included in the prices above: accomodation in the Maya Rose or Lotus House, three vegetarian meals a day, daily yoga, unlimited tea service in the restaurant, unlimited filtered water, taxes, group sauna and/or hot tub, Artisan market. Full spa services, organic juice bar, massage, kayaking, climb a volcano, horseback riding and water skiing are available for you at additional cost. There is the option of adding fish or chicken to your meals, if you wish, see Villa Sumaya website for costs. Exclusions: all transportation costs, airfare, airport shuttles, water taxis, excursions, body work that is available at Villa Sumaya, gratuities for Villa Sumaya staff.
  57. Please select a payment option:(*)


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  59. Mail cheque to: Karen Keresturi 546 Christina St. North, Suite 502 Sarnia,Ontario N7T 5W6
  63. Declaration & Acceptance of Forms
  64. I hereby declare the information in this application to be true and complete. I understand that providing false information is grounds for rejection of this application, expulsion from the program.
  65. I have read and accepted the requirements(*)

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  67. Upon receipt of this application and your deposit we will send you a Welcome package and more information about booking your hotel in Antigua, FAQ about Guatemala and the retreat. If you have any other questions, please do not hesitate to contact kkeresturi@hotmail.com.
  68. Thank you for your willing participation in this adventure. May you be blessed by the divine, now and into infinity. Om Shanti.
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