Align Retreat Registration Form

Align Retreat

It's time to align yourself with the person you want to be & the people you want to attract.
Your Name:*

First NameLast Name
Birth Date:*

MonthDayYear
Mobile Phone Number:*
Email Address:*
example@example.com
Desired Pronoun:*
Primary Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please provide any medical/dietary restrictions or preferences you have:*
Please Note: we will be doing a Cacao Ceremony. It is not recommended for people taking MAOI Anti-depresssants or anyone with a heart condition to consume pure cacao. Can cause migraines and increase blood flow. For greatest results, we ask that you come into this experience on an empty stomach. Please avoid dairy 12 hours before.
How did you hear about the Retreat?:*
How many days are you wanting to attend?:*
What Room/Bed are you interested in?:*
How do you want to pay?

CashE-transferCredit
What is the best way to contact you?*

TextCallEmail
Do you have a Passport & can cross the border?

YesNo
Extra Information

The fun stuff (optional)
Favourite Song

Your Reason For Taking This Path...
In 300 words or less, please describe your reasons for wishing to attend this retreat.*

0/300
Packing List:

Bathing SuitYoga MatYour Favourite MugWaterbottleAthletic GearAn Outfit for Saturday Dinner (Dress Your Best!)Slippers: OptionalRobe: OptionalBlanket: Optional
Should be Empty:

Align Retreat