Reclaim Retreat: Expression of interest
Fill out this form to let the faciltator know you are interested in the Reclaim Retreat.
Name
*
First Name
Middle Name
Last Name
E-mail
*
example@example.com
Mobile Number
Preferred Pronoun
Do you have any experience with Conscious Connected Breathwork (sometimes known as other names such as Transpersonal, Holotropic, Rebirthing or Shamanic Breathwork etc.)?
*
Experience with Breathwork is not required.
Please note that Transpersonal Breathwork (or Conscious Connected Breathwork) is NOT suitable for: people with cardiovascular problems, pregnancy, some psychiatric conditions, psychosis, recent surgery or fractures, acute infectious illness or epilepsy, severe hypertension, glaucoma, or active spiritual emergency.
*
I have none of these conditions
I have one, or more, of these conditions and would like to discuss this with the retreat facilitators.
What interests you about this retreat? What are you drawn to or hope to experience?
*
Please let us know any particular questions/comments/niggles you have on the retreat.
*
How did you hear about our retreat?
*
Are you aware this is an outdoor camping event?
Yes I have access to camping equipment
No
Would you like to be on Body Being's Breathwork related distribution list?
*
Yes
No
Back
Next
Submit
Should be Empty: