ThailandKoh Samui April 27th - May 3rd Retreat Submission Form Please fill out the questions below so I can learn a little more about you, your room preference, and all info needed to join the retreat. *Please note this is a 1st come 1st serve basis. You will be contacted if space is available after submission to place your deposit. Name * First Name Last Name Email * Phone (###) ### #### Date of Birth MM DD YYYY Gender Social media handle - Instagram @ / Facebook * Where will you be traveling from? Room Selection All rooms are private. I do not group people together unless specified Lotus Pad - Twin bed single occupancy $2,845 Lotus Pad - 2 Twin beds double occupancy $2,435 "per person" Lotus Pad - King bed single occupancy $3,050 Lotus Pad - King bed double occupancy shared bed $2,500 "per person" Prana Cabana - Twin bed single occupancy $2,900 Prana Cabana - 2 Twin beds double occupancy $2,475 "per person" Prana Cabana King bed single occupancy - $3,150 Prana Cabana King bed double occupancy shared bed $2,585 "per person" Prana Cabana *Plus - Twin bed single occupancy $3,100 Prana Cabana *Plus - 2 Twin bed double occupancy $2,555 "per person" Will you be attending with a friend / family member/ partner? * This will help us to place you together. *Please have all attendants fill out this form If traveling with friends, family members or partners please list their name(s) If choosing the Garden triple, please specify if you want to be on a waitlist to be placed with other travelers or list all 3 who will be staying in room. Dietary Restrictions / Requirements Medical Conditions / Injuries * Tell us about You! Any thing else you would like us to know Thank you! We hope to see you in Koh Samui
