2019 Mexico Retreat with Scott & Shanti Medina: Registration Form
Thank you for registering for our 2019 . We are so looking forward to sharing in this journey with you. Please complete this short registration form and follow the next steps to secure your space: 1) Please send in your retreat investment via paypal or check to SoMAntra, LLC 2) Please contact Mar de Jade to secure your lodging and let them know you are registering for "Embodying the Elements" with Shanti and Scott Medina March 30-April 6, 2019. Please contact Shanti if you should have any questions about this form or the retreat in general at Shanti@EnergizeShanti.com
Full Name *
Your answer
Address *
Your answer
Cell Phone Number *
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Email Address *
Your answer
Please indicate which lodging you are planning to secure with Mar de Jade Wellness Center. If you are lodging with other people, please indicate their names here as well. *
Your answer
The chefs at Mar de Jade prepare gourmet meals with options for meat eaters (chicken and fish), vegetarians, vegans and gluten-free diets. Please let us know your preferences and any dietary restrictions, so the kitchen staff can plan accordingly. *
Your answer
Emergency Contact Information *
Please provide name, phone number and email address for an emergency contact for us to use while you are at the retreat
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Do you have any other important information you would like to share?
Do you have health concerns or specific needs pertinent to this retreat?
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