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Name
First Name
Last Name
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2
Email
example@example.com
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3
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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4
Values
Here 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?
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5
Intention
Briefly 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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6
Celebration
What's your favorite thing about yourself?
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7
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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8
Availability
Are you available to attend the FULL retreat in Temecula, CA on March 4-7th, 2023
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9
Travel
Are you able to fly/dive yourself to this event and get yourself home? (Travel Accommodations are not included)
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10
Food
Do you have any specific dietary restrictions or health specifications we should know about?
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11
Food, continued...
If you answered, "yes" - please specify below.
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12
Investment
Are 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
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13
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?
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