Registration for 2019 Pilgrimage to India Welcome! We're excited for you to join us for the Wonder Wander Wellness Pilgrimage to India, February 4-17, 2019. Enrollment is on a first-come, first-serve basis. To enroll, you must: 1) Complete this form 2) Download, print, and mail in our Liability Waiver Form. 3) Secure your spot with a minimum $250 deposit. You will see links to download the Liability Waiver Form and make your payment after completing this form.Name* First Last Date of Birth* Nickname or Preferred NamePreferred PronounMailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone*Email* Choice of Accommodation*This will be based on your payment, but it's helpful for us to have it here also. Tour cost, not including airfare, is $3050 (double) and $3550 (single) If you pay by October 4 2018, increasing to $3350 (double) and $3850 (single) after October 4 2018. Single RoomDouble RoomPassport number*Please note -- you must have 12 photocopies of your passport, one for each hotel. We have found that this expedites check in procedures at hotels immensely.Passport expiration*Do you have any allergies we should know about?*Are you pregnant or currently taking any medication that may limit your physical or mental functioning? If yes, please detail.*Please briefly describe any physical or emotional limitations or difficulties you have that may be aggravated by participation in this tour.*Is there anything that would be helpful for us to know about your specific learning styles or needs?*Have you traveled to India before? If so, where and when?*What would you like to gain from this retreat personally or professionally, related to yoga or anything else?*PhoneThis field is for validation purposes and should be left unchanged.