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Wilderness Wellness Registration
We cannot wait to share this experience with you! We hope this retreat will be life changing. A time truly dedicated to yourself; focusing on health and happiness through food, movement and community.
Please fill out for this form to save your spot for the program.
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Name
Your answer
Email
Your answer
Phone #
Your answer
Do you agree to be added to the Wilderness Wellness Whatsapp group
Yes
No
Clear selection
Any allergies / dietary restrictions
Your answer
What areas of health would you want to improve most?
Mental
Physical
Emotional
Existential
Relational
Environmental
Other:
Since we will be camping overnight:
I have a tent I can bring
I am willing to share the tent I bring
I do not have a tent
I am willing to share someone else's tent
Other:
If you answered that you have a tent and you can share- how many people does your tent sleep? Thank you!
Your answer
Please bring a sleeping bag (or anything else you'd be comfortable sleeping with) Please mark YES if you understand
Yes
No
Clear selection
Payment
To save your spot and finalize your registration please send your payment of 490NIS by:
Bank Transfer: Naomi Eastman, Bank Hapoalim, Snif 582, Account # 146260
Bit: 054-650-7179 (please add your name & Wilderness Wellness in the description)
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