The Awakened Feminine Retreat Registration

First name

Last name

Phone

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

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Date of Birth

Requested Roommate

Do you have any dietary restrictions or allergies we should be aware of? If so, please list them here:

Emergency Contact Info

Do you have any injuries or a medical condition we should be aware of? If so, please list them here:

What is your main intention with going on this retreat?

What expectations, longings or desires do you have for this retreat?

Please read the terms and conditions and release of liability prior to your registration and participation in this retreat.

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Release of Liability / Electronic Signature

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