Retreat Application
Select Retreat Option:
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Oct 24-27 Custom Women's Wellness Retreat
Jan 31-Feb 2 Winter Women's Wellness Retreat
March 7-9 Spring Women's Wellness Retreat
Name
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First Name
Last Name
Age
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Email
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example@example.com
Phone Number
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Address
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Street Address
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City
State / Province
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Emergency Contact: Name
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First Name
Last Name
Emergency Contact: Phone Number
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How did you hear about this retreat?
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Friend / Family
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Do you have any allergies/sensitivities? (e.g., foods, environmental, oils, perfumes, etc.):
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No
If you checked yes, please specify:
Do you have any physical limitations or emotional/mental health concerns that may restrict you from practicing mindfulness, stretching, walking, or meditation safely? (e.g., high or low blood pressure, recent injury or surgery, mental health issues, etc.):
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Yes
No
If you checked yes, please specify:
What are you hoping to experience or learn during this retreat?
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Application Fee
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