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R E T R E A T
11th, 12th and 13th OCTOBER
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Name
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Email
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Phone Contact
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Current Ocupation
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Birth date
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6
What are you most looking forward to?
Relaxing
Yoga
Time in nature
Meditation
Ice bath Workshop
Creativity Workshop
Self-knowledge activities
Healthy food
Outdoor activities
Meet new people
Other
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7
What are your
goals
for the Retreat?
Relax/Stress reduction
Increased energy
Muscle tone
Move the body
Practice mindfullness
Focus & Productivity
Detoxify
Spend time in nature
Weight Loss
Try something new
Reconnect
Get to know me better
Improve physical health
Improve mental health
Overall health and wellness
Other
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Yoga Level:
Never tried
Begginer
Intermediate
Advanced
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Any existing health conditions or injuries? Please specify
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Any food allergies? Please specify
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11
REGISTER & ACCOMMODATION
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PAYMENT TO IBAN: LT063250017444387035 BIC/SWIFT: REVOLT21 Beneficiary: Sofia Ribeiro
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Order Summary
Total Price
EUR
DIGITAL DETOX RETREAT (EXCLUSIVE EARLY BIRD PRICE) - Shared Lodge
EACH LOGDE INCLUDES: ROOM + PRIVAT BATHROOM + KITCHENETTE + PRIVATE BALCONY
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Apartment size
Quantity
Price
4 people apartment
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€
360.00
2 people apartment
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€
400.00
DIGITAL DETOX RETREAT (EXCLUSIVE EARLY BIRD PRICE) - Private Lodge
EACH LOGDE INCLUDES: ROOM + PRIVAT BATHROOM + KITCHENETTE + PRIVATE BALCONY
€
500.00
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12
What other ESSE MOOD services you might be interested in?
Other Retreats
Workshops
Teambuildings
Wellness Coaching
Monthly Memberships
Online Workout/Yoga classes
Other
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13
Terms and conditions:
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Registration and Payment:
Registration for the Retreat is only considered effective upon the full payment of the fee. Participants can make payments via bank transfer or cash. Payment details are above and will also be provided via email after filling out this form.
Individual Responsibility:
Each participant is responsible for their own safety during the retreat. ESSE MOOD is not liable for injuries, damages, or loss of personal property during the retreat.
Changes and Cancellations:
ESSE MOOD reserves the right to change dates, times, or cancel the retreat for unforeseen reasons. Participants will be notified in advance, and fees paid will be fully refunded in case of cancellation.
Refund Policy:
Cancellations made by participants with a notice period of 5 days will receive a full refund. There will be no refund for cancellations made less than 5 days before the start of the retreat.
Disclosure of Other Events:
The provided email address may be used to send information about future events, campaigns, and activities related to ESSE MOOD.
Photographic and Audiovisual Record:
By participating, registrants agree that images and videos captured during the retreat may be used by ESSE MOOD for promotional purposes.
Privacy and Security:
The email address and personal information provided in this form will be kept confidential and will not be shared with third parties without your consent.
I have read and agree to the above terms and conditions
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