Shifting into Vitality Retreat Intake
Answer a fewcquestions to help us match you with the right retreat experience.
Full Name
*
First Name
Last Name
Age
Email Address
*
example@example.com
Whatsapp number (so we can contact you easier)
What's your occupation
Where will you be travelling from
How would you describe your current energy levels?
*
Very high
High
Moderate
Low
Very low
How would you rate your general health?
*
Excellent
Good
Average
Fair
Poor
How often do you feel stressed or wired?
*
Almost always
Often
Sometimes
Rarely
Never
What motivates you to participate in this retreat?
*
Have you attended a men's retreat or participated in men's work before?
*
Yes, several times
Yes, once
No, but I'm familiar with men's work
No, this is my first experience
What are you hoping to gain from this experience?
*
How do you currently support your physical and emotional well-being?
*
Is there anything else you would like us to know about you or your intentions for this retreat?
Investing in yourself is part of the commitment. When it comes to an experience like this, what feels realistic for you to invest in yourself right now? Payment plans are available — this just helps us understand where you're at.
$3,000+, $2,000–$3,000, $1,000–$2,000, Under $1,000
Money aside — how much do you want this right now?* (1–10 scale)
*
Not motivated
1
2
3
4
5
6
7
8
9
Extremely motivated
10
1 is Not motivated, 10 is Extremely motivated
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