Beautiful, Precious Me Registration form.

We are looking forward to hosting you at Siliano Alto for the May 1st Beautiful, Precious Me retreat. Please fill in the form below so that we have all your information.

Tell us about you - Step 1 of 6

Name *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Occupation

Date of Birth *

Passport Number *

Place of issue *

Passport Expiry *

Your passport must be valid for 6 months after date of arrival

In case of emergency contact: *

First

Last

Emergency Contact Phone Number *

Their Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Relationship to you: *

Please let us know what you love to eat and what you do not eat.

Do you have any other dietary requirements or allergies?

Please share any medical / health conditions you would like us to know about.

Are you taking any medication? If so please state below.

You must make sure that you have adequate supplies with you for the duration of the retreat.

Is there anything else that you wish to share with us, which will help us support you through the retreat?

Please give us your full travel details. Your airline, flight numbers and departure and arrival times: *

If you are arriving to us by train from any of the major airports or staying in a city for a few days first please let us know the details below. Our facilitators will be in touch to arrange picking you up from Chiusi Train Station. *

Client Agreement - It will be my choice to receive an Amatsu therapy and join in with Tai Chi on this retreat. All workshops and activities are optional. *

I accept the Client Agreement.

Terms & Conditions - By attending this retreat with Shine Retreats, I agree its owners, teachers and any person employed by Shine Retreats are in no way responsible for the safekeeping of my personal belongings. I agree that neither I, my heirs, assigns or legal representatives will sue or make any other claims of any kind whatsoever against Shine Retreats or its members for any personal injury, property damage/loss, or wrongful death, whether caused by negligence or otherwise. *

I confirm that I have read and accept Shine Retreats Terms and Conditions

Photo Release - Shine Retreats uses images and videos of people on retreat enjoying workshops, talks, meals, and shared events, for website and marketing purposes. Shine Retreats does not identify any person by name unless it has received specific written permission to do so. In consideration of the above, I hereby grant Shine Retreats permission to photograph, film, and make audio and/or video recordings of, me, and to use and display these on Shine Retreats website, archives, and promotional and/or informational material, and in any and all media. I hereby waive and release any right to compensation for, or ownership of, such photograph(s), film(s), and audio and/or video recording(s) of me and the above uses of them by Shine Retreats. *

I confirm that I have read and accept Shine Retreats Photo Release Terms and Conditions

Signature *