Full Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

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Birthdate *

MM

DD

YYYY

Name *

First Name

Last Name

Phone *

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Do you have any health issues/medical conditions that we need to know about? *

Yes

No

Do you have any specific injuries that we need to know about? *

Yes

No

Are you taking any medications?

Yes

No

Do you consider yourself:

Omnivore

Plant-based

Vegetarian

Vegan

Do you prefer

Red Wine

White Wine

Beer

Don't drink alcohol

Do you have any food allergies, restrictions, or preferences? Feel free to get as specific as possible so we can make sure to accomodate your needs.

Yes

No

Please check box: *

I understand that it would be optimal for me to take a few yoga classes in my area prior to the retreat.

Do you have any specific health, fitness or mindset goals you'd like to share wth us?

Yes

No

Please check box: *

I understand that we will be hiking at high altitudes and this requires working towards a strong cardio fitness level prior to the retreat.