Application For Breathe with Regina - Luxury Retreat Experience in Flagstaff / Sedona, Arizona

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Thank you so much for your interest in this luxury retreat experience in the beautiful vortex of Sedona, AZ. This retreat will allow you to disconnect from your day-to-day life, reconnect to yourself, and connect with other like-minded women. Because we want this experience to be aligned for everyone involved, we want to ensure everyone coming has similar intentions and that the group is curated for this experience. We can only take 10 people for the experience.

Email *

Name *

Phone Number *

Email Address *

Social Media Handles *

Are you interested in a shared room or private suite? *

Shared - Room ($2500 Early Bird Investment) - Payment Plan Available

Private - Room ($3000 Early Bird Investment) - Payment Plan Available

How interested are you in coming to this experience? *

Interested

Fully Committed to Coming

What is your intention in coming to an experience like this? *

Connection

Vacation

Spiritual Experience

Other:

What are you most excited about in this experience? *

What is something you would like to see in this experience? *

Anything else you want to share with Regina? *

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