Hill Country Weekend Reset Application Form
I'm so excited that you're joining me for this magical Weekend Reset! Please fill out this form to begin the process of reserving your spot. I will reach out to you within 24 hours of receiving your application to confirm your spot and arrange payment. Payment must be received within 48 hours of my follow-email or I'm afraid your spot will be released. If you have any questions at all, feel free to email me at: Alia@AliaJKhan.com! 

xoxx, 
Alia
Sign in to Google to save your progress. Learn more
What's your full name?  *
What's the best email address for me to use to communicate with you?  *
Which Lodging Option are you choosing?  *
Which Lodging Option are you Choosing?  *
If you are choosing Double Occupancy (or more, for the Slumber Party Casa), please provide the name and email address of your roommate(s).
Which Pricing Option are you Choosing? *
What's your preferred payment method?  *
Any dietary restrictions or preferences that I should know about?  *
Is there anything going on with you physically, mentally, or emotionally that could affect your practice and/or that I should know about? (Injury, pregnancy, stress, grief, any recent major changes in your life, etc.) *
Emergency Contact Name + Phone Number *
What inspired you to sign up for this retreat? Do you have any goals or intentions for the weekend that you'd like to share with me? 
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Oak + Lotus. Report Abuse
Google Forms