Retreat Registration
📅 Date: TBD – Check back soon for upcoming retreat dates. Complete this form to be first on the list!
Full Name
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First Name
Last Name
Email Address
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Phone Number
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Area Code
Phone Number
Emergency Contact Name & Phone
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Have you worked with somatic or embodiment practices before?
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Please Select
Yes, I have a regular practice
Some experience
Curious beginner – this will be my first time
Prefer not to say
What are you hoping to receive from this retreat?
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Any dietary needs, allergies, or physical considerations I should know about?
Sliding scale payment preference
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Please Select
Community rate (lowest)
Standard rate
Sustainer rate (supports scholarship spots)
I need more information before deciding
Anything else you'd like to share?
Should be Empty: