Dig Deep. Reach High. Find Peace Retreat With Larisa Stow & Jody Potiker - 11/15/19
Registration Questionaire
Email address *
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Name *
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Phone Number *
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Physical Address *
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Have you participated in these types of workshops or retreats before? If so, please elaborate
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How did you hear about this retreat? *
Are you coming with someone and if so, whom and do you want to share a room or bed with them? *
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When do you plan to arrive? *
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Are you interested in carpooling?
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If yes, where are you coming from?
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If you want to carpool, are you planning to drive or do you want to be driven? If you are wanting to drive, how many passengers can you take? *
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Do you have food restrictions? If so, describe (please be as flexible as possible since we are trying to please a whole group of women! Please be clear about sensitivities/allergies vs. preferences *
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Single rooms may be available for an extra cost (approx $150). Is that something you would be interested in?
Are you a morning person or a night owl?
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If you are being matched up with a roomate, do you snore? Are you bothered by other people snoring?
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Do you have any medical conditions that may require emergency attention? This would include heart conditions, asthma, epilepsy, diabetes needing insulin injections etc. If so, what action would be required if you have an emergency? *
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Please give an emergency contact name, email and phone number. Thank you. *
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Do you have any special requests heading into the weekend?
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Please make any additional requests or comments here- Thanks for your participation!
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To hold your spot, please send payment of $475 via paypal friends and family to larisastow@msn.com or Venmo @Larisa-Stow-Norman. If necessary, a $200 deposit can be made now and the balance on Nov. 15th. We prefer payment in full now if at all possible!
I will email you a list of suggestions about what to bring in a few weeks so please keep an eye out!
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If you have any questions regarding logistics, lodging, payments, carpooling, food or anything else, please text or call Jody at (707)484-2066 or email cooljode@gmail.com. Thanks!
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