Customer Information Form

Customer Information Form

For Retreat Leaders and Facilitators
Contact information
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Profession*
Your line of work.
Your Role*
Describe in a sentence or two what you do on a daily basis.
How can we help you?
What services are you enquiring about? Please select all that apply.*

I want to hire you to plan my retreatI want to hire you as a facilitator or co-facilitatorOther (please add more info below)
Other - Please specify
I want to hire you to PLAN MY RETREAT
What TYPE OF RETREATS are you interested in (select all that apply)*

Wellbeing RetreatMindfulness RetreatYoga or Pilates RetreatTeam Building RetreatBespoke Corporate RetreatBespoke Family and/or Friends RetreatAdventure RetreatCreative Retreat (Cooking Classes, Dance Classes, Arts & Crafts, Photography etc.)Other (please specify below)Bachelorette RetreatPost-Wedding RetreatOther
Other - please specify
Ideal Date/s*
Or months & year if you are flexible
Preferred Location*
Country, Specific Location
Estimated Number Of Participants*
What SERVICES are you enquiring about? Please select all that apply.*

Venue SourcingProgramme / Itinerary DesignLogisticsCateringSales Page DesignMarketingHelp with Budget / PricingBudget Management / PricOnsite CoordinationOther (please add more info below)
Any Specific Themes, Goals, or Outcomes For Your Retreat?*
I want to HIRE YOU AS A FACILITATOR or CO-FACILITATOR
Type of event*

1 Day WorkshopMulti-Day WorkshopRetreat (3+ Days)Other
Other (please specify)
Dates & Location*
Estimated Number Of Participants*
What topics or activities would you like me to facilitate?
Are you looking for a lead facilitator or co-facilitator?*

Lead FacilitatorCo-Facilitator
Any other facilitators involved?*

NoYes (please add names, their profession and the presentation topics below)
Names & topic/s they are going to facilitate
Example: Yoga Teacher, Meditation Facilitator, Health Coach etc.
Anything else you'd like to share?
Example: Yoga Teacher, Meditation Facilitator, Health Coach etc.
Should be Empty:

Customer Information Form

Contact information

How can we help you?

I want to hire you to PLAN MY RETREAT

I want to HIRE YOU AS A FACILITATOR or CO-FACILITATOR