Retreat Waitlist Registration Form

Retreat Waitlist

Registration
MaleFemale
Tulum,Mx: November 2024Thailand 10day Backpacking Trip (December 2024)Los Angeles - 3 Day Refresh & Reset Detox Retreat ( January 2025)Jamaica (Treasure Beach,/Negril): MAY 23 - 28,2025Other
Name*

First NameLast Name
Birth Date (Optional)

MonthDayYear
Email*
example@example.com
Phone Number

Area CodePhone Number
Social Media
(Optional: LinkedIn/ Instagram / Facebook/Website )
1:1 Private/Solo Retreat with Chandra Aiesha as your practitioner,host, & travel guide.Group Retreat 6+ personsSmall Group Retreat 3-5 personsWellness Vacay w. A Dash of Turn Up (little bit of everything)Unplug & Recover; Disconnect from the outside world and reconnect with selfDetoxWomb WellnessSisterhood/ConnectionTravel Companion/GuideSpiritual/ Emotional SupportHealing from dis-easeDigital Detox DayTransformational Experience/RebirthCouples Retreat / BaecationAdventure TravelCultural ExplorationPhotoshootLeadershipOther
No RestrictionsGluten-FreePlant Based / VeganOther
Word of MouthInstagramFacebookQueen By Nature WellnessOther
What do you wish to achieve from your Wellness Vacay Experience, What are your goals, and/or expectations?*
What is your level of comfort when it comes to getting into the water? (pool/ocean/lagoon/river/cenote)*
Do you have any health limitations or physical injuries? Trouble walking? Please indicate if you have any major health issues (ex high/low blood pressure, arthritis, asthma, diabetes, seizures, osteoporosis, mental health concerns, etc.)*
Are you bothered by scents (essential oils, incense, perfumes etc.)? If yes, please let us know the details.*
Do you have any Questions or would you like to elaborate on the retreat experience you would like curated?
(optional)
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