Ananda in Texas 2023 Kriyaban Retreat Registration "*" indicates required fields Contact InformationName* First Last Phone*Email* Dates of attendance* Friday Oct 27th - Sunday October 29th Sunday Banquet only (if you are paying for a private or shared room, banquet is included) HiddenDates of Attendance (select all that apply)* Saturday Day Pass Sunday Banquet What is your approximate time of arrival?* Room Selection*3 day/2 night cost including 2 breakfasts, Friday dinner, Saturday lunch and dinner, Sunday banquet Private $369 Shared $199 HiddenSaturday Day Pass*(includes morning sadhana, brunch, satsang, dinner, flowers and fruit for kriya) $149 Sunday Banquet Ticket* Adult $30 16 and under $15 Do you have a pre-selected roommate?* Yes No What is the name of your roommate? (Roommate needs to register separately)* Will you be joining us for meals?*Saturday brunch and dinner are included. Yes No Do you have any dietary concerns or restrictions you want us to know as we plan simple vegetarian meals? Please provide details below. If there are no concerns, please indicate that as well.*General Release of LiabilityIn the unlikely event that an accident, sudden illness, or even death should occur while traveling to and attending the Kriya Retreat events, Sunday Service, or Banquet, hosted by Ananda Dallas at the Springhill Retreat Center, I affirm with my signature that I shall not hold Ananda Dallas nor Springhill Retreat Center responsible for costs, damages, or liability resulting from participation from the activities therein. I fully accept responsibility for costs relating to any emergency that might arise during my time at and travel to the retreat center. My signature below is confirmation of the same.*Please sign below (required) Reset signature Signature locked. Reset to sign again Photography Release FormBecause we'd like to chronicle this retreat, we may like to use photos taken that could include you in them. Is that ok?* Yes No I agree that (please check the box):* I decline authorization of any likeness of mine in photographs used for promotional materials or on the internet. I agree that (please check the box):* I hereby acknowledge that this Photography release form (hereinafter referred to as "form") becomes effective on October 27, 2023.. I agree that (please check the box):* I hereby authorize the Ananda Meditation and Yoga Center of Dallas to make any use of all photographs of me to be used for promotional materials. I agree that (please check the box):* I hereby acknowledge that I will not be entitled to payment or any sort of charge for such action. I agree that (please check the box):* I authorize the use of my photograph for, but not limited to, publication on the internet, magazines, journals, books, articles, etc., provided that it is done for lawful purposes. I agree that (please check the box):* I hereby release all rights to any, but not limited to, claims, rights, demands, and/or any causes of action by me or my representatives, heirs or anyone else. I agree that (please check the box):* Furthermore, I hereby waive my right to any royalty or any other compensation with regard to the usage of the photos referred to in this Form. My signature below confirms that I agree with the above statements regarding photography.*Please sign below (required) Reset signature Signature locked. Reset to sign again CANCELLATION POLICYCANCELLATION POLICY: ACCOMMODATIONS:50% refund if cancelled by Sept 20th. All other guest cancellations after Sept. 20th are nonrefundable as we are within the cancellation policy window of the facility. PASSES AND BANQUET: All guest passes and banquet tickets are nonrefundable. If retreat is cancelled due to an act of God, government mandate, etc., we will reschedule the event and your registration is automatically transferred. Credit will be given if you cannot participate in rescheduled event.* By checking this box, I am accepting and agreeing to the above cancellation policy. PaymentRetreat Registration Fee Discount CodeIf you have been provided with a discount code in exchange for service, enter that here. (optional) Payment MethodPayPal CheckoutCredit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name Δ
