Journey to the Heart Registration Form
I am very excited to offer a relaxing and restoring retreat in Italy from April 17 to April 24, 2020. This retreat serves as an opportunity to connect with like-minded souls from around the world, and grow and open our hearts together in the bucolic scenery of Tuscany. Thank you for registering!

All genders are welcome. Minimum age for any participant is 18 unless otherwise agreed in writing at Judit’s discretion. There is no maximum age.
Email address *
PERSONAL INFORMATION
Your first name *
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Your last name *
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Your nick name
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Your date of birth *
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Your address *
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Your phone number *
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Your preferred method of contact *
Best time of day and day(s) of week to contact you *
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Name of emergency contact *
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Emergency contact's phone number *
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Emergency contact's relationship to you *
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MEDICAL & DIETARY INFORMATION
Do you have any medical conditions that we should be aware of? *
Write Yes or No in the box. If answer is Yes please provide explanation.
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Do you have any medication needs or requirements that we should be aware of? *
Write Yes or No in the box. If answer is Yes please provide explanation.
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Do you have any food allergies? *
Write Yes or No in the box. If answer is Yes please provide explanation.
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Please describe your preferences in regards to dairy (choose all that apply) *
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Please describe your dietary preferences in regards to gluten/wheat *
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