Portugal Retreat Registration Form

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Emergency Contact Name*

First NameLast Name

Emergency Contact Phone Number*

Please enter a valid phone number.

Injuries?*

Allergies

Please write anything you feel is important for us to know, such as fun facts about yourself, what are your expectations from the retreat and what would you like to learn as we are there.*

Pricing Includes :7 Nights of room and board, 3 Farm to Table meals per day, Daily classes and workshops, Surprise outing, (Transportation and Airfare not included). Pricing is per room.*

€3700 Single Room€4600 Double Room (2 people)

For Double Rooms Name of the person you are going with

First NameLast Name

How did you hear about us?*

I am interested in a massage at extra cost*

60 minute massage90 minute massage90 minute intuitive healingNot Interested

Payment Options*

Pay in FullPay in 2: €1000 Deposit due today + Balance due by 12/01/25Pay in 4:€1000 Deposit due today+ 3 equal payments due 11/01/25 , 12/01/25 and 02/01/2026

Premah Corp Retreat Payment Agreement

I, the undersigned, agree to make payments on the specified dates and in the agreed amounts stated on the payment schedule above to Premah Corp.

I understand and agree to the following terms:

Payment Methods & Currency

All payments must be made in Euros (€).
Payments are to be made through Zelle to: premahcorp@gmail.com, or via PayPal (a 3% processing fee will be added to each PayPal transaction).
Automatic Processing
Premah Corp will retain my credit card information on file and reserves the right to process my payment 5 days after the agreed due date if I have not completed the payment myself (in person or online). Credit card payments have an additional 3.5% fee.
Late or Defaulted Payments
1. If I fail to make my scheduled payments, penalties may include:
2. My account being turned over to a collection agency, and/or
  Legal action through small claims court.
3. In the event of default, I agree to pay: Any fees and costs incurred by Premah Corp in collecting the outstanding balance.
  A competitive interest rate on the amount owed.
  Legal Enforcement
Premah Corp reserves the right to pursue all legal means necessary to collect any unpaid debt.
My reservation is not completed until I send my full deposit.

By signing this agreement, I acknowledge that I have read, understood, and agreed to the terms above.

First Name Last Name Card NumberNumber* Expiration (MM/YY) (MM/YY) Security Code CODE Billing Zip Code ZIP

Name*

First NameLast Name