Temecula - Miracle Moment Retreat

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Name

First Name

Last Name

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Email

example@example.com

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Phone Number(we will only use this if we can't get ahold of you via email)

Please enter a valid phone number.

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ValuesHere at Miracle Moment Retreats, we value curiosity, presence, kindness, playfulness and lead with an open heart and mind as much as possible. Does that sound in alignment with the kind of experience you want to have?

YESNO

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IntentionBriefly describe your Intention for wanting to attend this particular retreat at this time? Examples: What energy do you intend on showing up with? What do you hope to get out of this experience? What are you hoping to release? Or learn about yourself? Etc.

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CelebrationWhat's your favorite thing about yourself?

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How did you hear about this Retreat?If it was thru a friend or colleague, please put their full name, so we can thank them properly! :)

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AvailabilityAre you available to attend the FULL retreat in Temecula, CA on March 4-7th, 2023

YESNO

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TravelAre you able to fly/dive yourself to this event and get yourself home? (Travel Accommodations are not included)

YESNO

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FoodDo you have any specific dietary restrictions or health specifications we should know about?

YESNO

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Food, continued...If you answered, "yes" - please specify below.

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InvestmentAre you ready, able and excited to make an Investment in yourself for this Experience? This includes Room Accommodations for your entire stay, ALL Meals, Snacks & Drinks, Any Local Excursions, All Classes, Workshops, 1:1 Coaching and Healing Sessions, and Massages, etc. plus a Thank You Gift Bag and a 3-Month Follow Up Session with the Coach or Healer of your choice. Total Investment: $4,000 per person. *Room Availability is "first come first serve" upon signing up. *And Payment Plans Are Available - Just Ask. xoxo

YESNO

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Ready For Your Miracle Moment?Based on everything you've read and filled out, would you like us to send you the link for payment so you can secure and select your room?

YESNO