Emergence through Belonging

Emergence through Belonging

Thank you so much for your interest in attending this women's only retreat. Please complete this application for attendance. All fields are required to be completed and I will let you know if your application is successful, or if I need further information. Innana Rakma
Applicant Details
Full name

First NameLast Name
Emergency contact name

First NameLast Name
Emergency contact phone
Please enter a valid phone number.Format: 000 000-0000.
Date of birth

MonthDayYear
Date
Where do you live?
Mobile number
Please enter a valid phone number.Format: 000 000-0000.
What do you do for a living?
Health, Background, and Intentions
Any illness or medical issues?
Do you have much experience with yoga and meditation?
Any injuries that may make yoga difficult for you?
On any medication
If yes, please expand
Have you had ceremonial cacao before?
Have you done much self development work?
Are you able to accept self-responsibility?
What are your major stressors at the moment or over the past 3 months?
Human Design type — if unknown please check www.mybodygraph.com
Human Design profile numbers
Why do you want to attend the retreat?
What do you hope to get from attending the retreat?
Stress level

1

2

3

4

5

6

7

8

9

10

1 is Lowest, 10 is Highest
Have you attended women's only retreats before
Dietary restrictions
Accommodation and Payment
Preferred accommodation option
Payment option
Investment for full weekend $650-$750 per person
Energetic Coherence Session Check
Have you had a recent (last 3 months) energetic coherence session with Mandi?
Are you prepared to have a 1 hr session at a reduced cost of $200 prior to attending the retreat?
Part of this retreat to promote the sense of belonging and unity is to provide a meal to share for Friday evening and Saturday lunch in potluck/casserole form (probably vegetarian to be conducive to dieatry restrictions - but we will wait and see!), if your application is successful - what do you think you might bring? ( Mandi will provide breakfasts and Saturday evening dinner, as well as Sunday lunch, breads and salads)
Is there anything else that Mandi needs to know about you attending this retreat?
We'd love to encourage you to keep this a tech free zone for the weekend, and you are welcome to use Mandi's number as the emergency contact.
I accept all responsibility for any injuries, mishaps, etc.
I accept all responsibility for any injuries or mishaps, that may or may not occur and understand that by partaking in this retreat, I do not hold Mandi J Nelson, or Cocoon Retreat, liable. I have provided any information that may be helpful to Mandi to sustain my care.
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Emergence through Belonging

Applicant Details

Health, Background, and Intentions

Accommodation and Payment

Investment for full weekend $650-$750 per person

Energetic Coherence Session Check