2027 Una Vitality Goddess Retreat Form

1

Full Name* This field is required.

2

Email* This field is required.

3

Cellphone* This field is required.

4

Tell me a bit little about you.* This field is required.

5

How would you describe the season of life you're currently in? What's going well? What challenges are you facing?* This field is required.

6

What beliefs or stories do you already know you're ready to leave behind so you can step fully into your new vitality* This field is required.

7

What would make this intensive the best possible experience for you? What would you love to walk away with that would help you feel like you're in your new era?* This field is required.

8

Would you be interested in the Shared Goddess Experience or a Private Goddess Experience? * This field is required.

9

If Interested in a shared space, what is your sleep schedule?

Early Bird (before 9:30PM)

Moderate (10:00PM-11:00PM)

Night Owl (after 11:00PM)

N/A

10

Morning Routines (Shared Experience)

Quiet Mornings

Social Mornings

NA

11

Room Temperature (Shared Experience)

Cool

Moderate

Warm

NA

12

Noise While Sleeping (Shared Experience)

Complete Silence

White Noise

Doesn't Matter

NA

13

Cleanliness (Shared Experience)

Very Neat

Moderately Organized

Relaxed

NA

14

Social Preference (Shared Experience)

I Enjoy Chatting

Balance of Social & Quiet Time

I Value A Lot Of Personal Space

NA

15

Which payment option are you interested in?* This field is required.

$3,540 in full (Shared Goddess Experience)

$4040 in fill (Private Goddess Experience)

Payment Plan

16

Dietary Restrictions* This field is required.

17

Emergency Contact (name, cellphone & email)* This field is required.

18

Is there anything else you'd like us to know so that would help us make this the best possible experience for you?* This field is required.