Personal Retreat Registration Form

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone*
Date of Birth*
MM slash DD slash YYYY
Occupation*
What do you most deeply desire or long for?*
What is your current understanding of the meaning of life …what most matters to you?*
What authors, teachers, practices, or experiences have been most helpful to your life?*
How can you best describe your personal spirituality… and how is it most reflected in your daily life?*
How many days are you looking to retreat? Full days? Overnights? Specific hours? Please be as specific as possible.*
Are you looking for a one on one retreat ? If not, how many people do you plan to have attend? How are you related?*
Why do you feel guided to a personal retreat?*
I offer many areas of focus in my retreats. What areas do you feel guided to focus on at this time?*
What months/days/dates are best for you?*
Do you plan to rent a car?*
Do you plan to stay in AZ longer than just the retreat time?*
Sedona is a big tourist spot here in Az. Are you interested in going to Sedona during this time? I could include a Sedona day for you, as part of your retreat, if you feel so guided, and I can be your guide to some of the vortexes, hiking trails, etc. If you have already been, are not interested, or would rather explore on your own, that would be fine as well.*
Do you have any handicaps or physical limitations that I need to know about in advance?*
What else do you feel I need to know about you to set up the best experience possible for you?*
Consent*
- I consent to my submitted data being collected and stored

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Personal Retreat Registration Form

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