EmailMe Form - Stradbroke Island Retreat

Name *

First Last

Email *

Phone *

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Payment Form (Full amount $495) *

Credit Card

Bank Transfer

For Credit Card payment: *

This a secure form with SSL encryption for your protection.

Bank Transfer:

Commonwealth Bank Name: My Health Yoga BSB: 064-430 ACC: 1145 0472

Special Dietary Requirements (if any):

The retreat fees must be paid fully 1 month prior to the retreat date.

By submitting this form I agree that 50% of the total amount is non-refundable to cover administration fees. *

I agree