Seasonal Home Cleanse Registration

Registration form for the Illumine Ayurveda and Yoga Seasonal Home Cleanse, October 17 - November 8, 2026

First name

Last name

Gender

Date of birth

Address

Phone Number

I confirm I am registering for:

Seasonal home cleanse - $225

Seasonal home cleanse with consultation - $350

How did you learn of the seasonal cleanse? If you were referred by someone please include their name. If you found it online, let us know where (social media, Google search, website, etc.). If you learned about it another way, please describe.

Why are you joining the seasonal cleanse group?

If you selected other in the question above, please describe.

Do you have any dietary restrictions or allergies?

Describe your experience with yoga asanas (poses), pranayama (breathing techniques), meditation.

Please share your experience with Ayurveda. How familiar are you, have you been through a seasonal cleanse in the past?

What do you hope to achieve by your participation in the cleanse?

Do you have any questions you'd like to discuss about the cleanse?

I acknoweldge and agree that no refunds are provided after payment is made, for any reason. If registration is cancelled at least 48 hours before event begins, program fee will transfer to credit with Illumine Ayurveda & Yoga that can be used within 1 year of payment date. Cancellations less than 48 hours before the start of the event are not eligible for refunds or credit.

I am ready to send my payment and receive the introductory information - please send payment information.

I would like to schedule a Clarity Call to discuss questions I have. Please send me a link to schedule a call.

I would like to subscribe to the mailing list. Please add me.