Yoga Retreat Signup Form — Conscious Impact

JOIN US IN NEPAL FOR YOGA, SERVICE WORK AND THE CELEBRATION OF NEPAL’S MOST BEAUTIFUL FESTIVAL!

Please fill out this form to let us know that your are interested in attending our “Yoga, Rice Harves and Tihar” Retreat in Takure, Nepal. Once you have filled out the form, we will reach out to you directly to discuss further details.

Thank you for your dedication to serving the community of Takure while practicing yoga in the Himalayas!

Name

First Name

Last Name

Email Address

How did you hear about Conscious Impact?

(Friend that volunteered with us? Saw on Facebook or Instagram?)

Are you already in communication with anyone on our team?

If so, whom and over which platform (email, facebook, or instagram).

Phone number

(Please include your country code)

WhatsApp Number

For our team in Nepal to be able to reach you. If you do not have, leave blank.

Birthdate

YYYY

Current Location & Timezone

Birth Country

Which retreat are you interested in attending?

Yoga, Rice Harvest and Tihar (November 11-17, 2023)

Other

During which dates do you plan to stay at the Conscious Impact camp?

Do you hope to arrive before the retreat or stay after? Or are you just visiting for the retreat?

Will anyone else be joining you on your trip?

Why are you interested in joining this retreat in Nepal?

What skills, interests and/or experiences do you have that you feel are relevant to this retreat?

No experience is required. This is only to help us better know you.

What specific expectations and learning goals do you have for attending this retreat?

This helps us understand if this course is right for you

Any other information you would like to share? Comments? Questions?