Men's Weekend Reset with Embodied Mind

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Men's Reset Weekend May 10-12th, 2024

Embodied Mind NYC

Location:

Nine Mountain Retreats

9 Mountain Street

Plainfield, MA 01070

https://ninemountain.com/

Email *

Record my email address with my response

Full Legal Name *

Date of Birth *

Email Address *

Home Address *

Phone Number *

Dietary Allergies, Needs, or Preferences *

Bed/Room Options

*Please Review- Accomodations Outline

*First come, first serve. Choose top 3 choices.

*No longer available- Queen in Private, Queen in Shared

Single in Shared (dorm)

Top Bunk Single in Shared (dorm)

Bottom Bunk Single in Shared (dorm)

Choice #1

Choice #2

Choice #3

Bodywork Upgrade

75 minutes for $150

Bodywork with John- learn more here

Yes

Maybe, I will let you know closer to the date keeping in mind the session slots may be full

Clear selection

Payment Policy

I understand payment is required in full to reserve my spot. Bed choices are on a first come first serve basis. Payment will be made via Credit Card on Embodied Mind's Client Portal, Therapy Partner. Administrator, Tamreh, will reach out to set up your account. Please confirm the account & add a credit card within 24 hours of completing this form.

I have read, and understand, the Payment Policy

Other:

Cancelation Policy

A 50% refund is available if canceled before March 30th. After March 30th all payments are non-refundable.

I have read, and understand, the Cancelation Policy

Other:

Getting There

RideShare Spreadsheet

I will drive there

I will take the train or bus to Northampton, and will order an UBER

I will take the train or bus to Northampton, and would like a Shuttle Ride to the Retreat (no charge)

I will drive there and I can take others with me in my car (fill out RideShare Spreadsheet)

I would like to ride in a car with someone else from New York (fill out RideShare Spreadsheet)

I'm not sure yet, and I will be in touch when I know

Other:

Required

Breathwork Contraindications:

Breathwork can result in intense physical and emotional release. Therefore, it is not advised for persons with a history of cardiovascular disease, including angina or heart attack, high blood pressure, glaucoma, retinal detachment, osteoporosis, significant recent physical injuries or surgery.

Breathwork is not advised for persons with severe mental illness or seizure disorders or for persons using major medications. It is also unsuitable for anyone with a personal or family history of aneurysms. Persons with asthma should bring their inhaler and consult with their primary care physician and the Breathwork class facilitator.

I have read, and understand, the Breathwork Contraindications

Other:

Program Agreements

By registering for this retreat I acknowledge the following:

Alcohol and other substance use (unless prescribed) is prohibited for the duration of the retreat

Sexual activity is prohibited for the duration of the retreat

Technology use will be limited during the retreat

In order to create a space that is conducive to risk taking and deeper connecting, I understand that anything said by me or shared by others in the space is strictly confidential, with the exception of my own personal experience and the impact of other’s on my own

Not adhering to any of the above could lead to my removal from the retreat experience without refund

I have read, and understand, and agree to the Program Agreements

Other:

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