Lead WITH Your Heart Retreat Application Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

November 15-17, 2019 | Beukenhof, Capucijnenstraat 46, 5074 PJ Biezenmortel, The Netherlands

Email *

What is your name? *

What is your Skype ID? *

What is your cell phone number? *

Why would you like to apply to come on this retreat? *

What do you hope to contribute? *

What would you like to accomplish by the end of the 2.5-day retreat? *

How would friends describe you? *

If you knew you couldn't fail, what would you do and why? *

Do you have any food allergies and/or dietary restrictions? *

The retreat will be held at a Retreat Center in Biezenmortel, The Netherlands *

I acknowledge that it will be held at a Retreat Center in the The Netherlands and I will find my own way there

I acknowledge that everything I say or hear other's say during the retreat will be kept strictly confidential. (Whatever happens at the retreat, stays at the retreat!)

I acknowledge that this is a preliminary response and there will be a follow up phone call.

I have the financial means to pay 688 Euros (before October 15) or 888 Euros (after October 15) if I find after the phone call that this retreat is aligned WITH me

I am open to sharing a room WITH another participant(s).

Other:

Required

Any additional questions/concerns? *

Send me a copy of my responses.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms