Nourish & Restore: Elemental Goddess Retreat
December 2-9, 2017

Please take a moment to tell us a bit about yourself so we can get to know you better. Don't worry, we're not into sorority-style rejections... we just want to make sure that what we have to offer is actually what you're looking for!

Email address *
What is your name? *
Your answer
What is your phone number? *
Your answer
Country of residence *
Your answer
Why are you excited for the Nourish & Restore Elemental Goddess Retreat? *
Your answer
What is your level of experience with yoga? *
Your answer
How would you describe your current spiritual practice (if any)? *
Your answer
How would you describe your food relationship? *
Your answer
Which room type are you interested in? *
Are you interested in setting up a payment plan? *
Is this a "hell yes!" or do you have questions you need answered before you can commit (list them here)? *
Your answer
Anything else you want us to know?
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Bit by Bit Nutrition, LLC. Report Abuse - Terms of Service