Detox Registration APPLICATION FORM CASA TERRA Your Name Your Email Telephone Age City Which retreat would you like to attend? East Sussex, Feb 5-7, 2016 Peru, April 8-15, 2016 Brazil, November 2016 How is your overall heath? Under doctors supervision Poor Average Above Average Heath issues: please list any illnesses or health issues. Make sure to list all present medications/treatments Have you completed a detox programme before? Yes No What level is your yoga practice? Complete beginner Dip in and out of practice Regular practice Advanced What style(s) of yoga do you practice/prefer? What would you like to accomplish by attending this detox retreat? Preferred language of printed material English Español How did you find out about the programme?