JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Fall Wellness Retreat - Goldeye Lake Mountain Resort
We are excited to have you join us on the weekend of September 25-27, 2026. If you have any questions, email Jeanette or Shona.
* Indicates required question
Email
*
Record my email address with my response
Full Name
Your answer
Phone Number
Your answer
Accommodation
Individual Private Room - 1 person
Shared Private Room - 2 people - one bed
Shared Private Room - 2 people - 2 singles
Clear selection
If sharing, who will be sharing it with you? (name and phone number)
Your answer
Dietary restrictions, please write NONE or list if any
Your answer
Emergency Contact Name and Number
Your answer
I have reviewed and undertand the payment breakdown and due dates. I will etransfer Jeanette Ward (jeanettew929@gmail.com, password: Namaste) to reserve and hold your spot, etransfer the non-refundable deposit of $525 (incl. gst). Write your name below to confirm this.
Your answer
Last question, out of curiosity, where did you hear about this retreat?
Your answer
A copy of your responses will be emailed to .
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report
