Awakened Woman Pre-Registration Form

Guest Information
The Awakened Woman Retreat: GHANA

March 22-March 30, 2024
Name

First NameLast Name
Email (Please double check spelling)
example@example.com
Birthdate

MonthDayYear
Date
Cell Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Have you visited Ghana before?
What are your 3 primary reasons to visit Ghana?
Do you have any health limitations or physical injuries? Please indicate if you have any major health issues (ex high/low blood pressure, arthritis, asthma, diabetes, seizures, osteoporosis, etc.)
Gender

MaleFemaleOther
Women: Are you pregnant or is there any possibility of being pregnant? If YES, please indicate your due date
Do you have any affiliations (personal, professional, religious) which would prevent you from bonding with others or participating in cultural, spiritual, and lifestyle experiences while in the Motherland? If yes, please let us know the details.
Do you have any special dietary requirements? (eg: gluten-free (please specify if you are celiac), allergies, vegan etc…)
Do you have a current, up to date passport? If no, do you plan to secure your passport by end of the year or earlier?
Are you or will you be prepared to put a deposit down of $1200 by September 15, 2023?
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Should be Empty:

The Awakened Woman Retreat: GHANA