Elevate 2022 – Signup (Adult) – ISKCON Pandava Sena

Elevate 2022 - Adult

1About You

2Health & Medical Issues

3Emergency contact details

4T&Cs + Payment

Name*
First Last
Email*
Email Confirm Email
Address*
Street Address City ZIP / Postal Code Country
Mobile Phone*
Your personal mobile number. Type 0 if you have no mobile number
Gender*
Date of Birth*
As stated in your passport. DD/MM/YYYY
DD slash MM slash YYYY
How did you hear about the retreat?*
Please specify

Illnesses or Allergies
Medication Required
Additional Information
Please inform us of any other illnesses or allergies and activities or foods which should not be undertaken as a direct result of these. Please also inform us of any dietary requirements.

Please provide us with the details of the person you are most happy for us to contact in the unlikely case of an emergency.
Emergency Contact Full Name*
Emergency Contact Number*
Relationship*
E.g. Mother, Father, Guardian, Friend

Terms & Conditions
Due to current circumstances, we require payment in full. Rest assured that if the trip is unable to continue due to government restrictions, a full refund will be given to all. For any other reason, please see Terms & Conditions
By checking the box below, you agree to our Terms & Conditions
*
- I agree
Payment
Credit Card
Card Details
Cardholder Name
Single Ticket*
Price:
Total
£ 0.00