Women Who See in the Dark - Registration form
Email *
PARTICIPANT DETAILS

Name you like to be called by

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Date of Birth

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Time of birth

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Time
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City and country of birth

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Gender identification

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Full name as per your passport

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Passport number

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Nationality *

Address of residence (city & country)

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Phone number (with country's code) *
Whatsapp number (with country's code) *
Website (personal and/or professional) *
Emergency contact name
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Emergency contact phone number *

Degree of connection with the emergency contact

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ABOUT YOU

Education

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Present Occupation

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Do you have any special needs related to nutritional choices?

If yes, please detail.

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Are you presently taking any medication?

If yes, please detail.

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Do you have any current health challenges?

If yes, please detail.

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Do you have any addictions?

If yes, please detail.

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Do you have any physical challenges?

 If yes, please detail.

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Do you have any experience with meditation practices?

If yes, please detail.

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Have you participated in workshops/retreats/events related to conscious sexuality?  

If yes, please detail.

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SELF REFLECTIONS
The next questions are important for yourself to reflect as for us to feel into you. Please make sure to take the time to answer properly, with enough details and self inquiry.

What calls you to participate in this retreat?

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What would you like to experience during this time?

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What would you like to “take home” as an outcome?

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What is the most relevant issue in your life at this moment?

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What does darkness evokes for you?

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Please, let us know something very meaningful about you…

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Anything else you would like to share?

REGISTER

How did you hear about Women Who See in the Dark?

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I would like to register to Women Who See in the Dark retreat at

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Required
Registration
To register your participation, please make a deposit of 800€ to this account:

Name: Lyra & Recotillon Lda
IBAN: PT50 0045 6044 4036 9491 0116 2
BIC/SWIFT: CCCMPTPL

If the bank account sending the deposit is not in your name (as stated in questions above), please give us the owner's details (person or company) for us to connect it with your registration form.

Once the deposit received, we will come back to you as soon as possible.

Thank you

Name on the account sending the deposit (if different than given above). If it is a company, please write the tax number if you want to get a receipt.
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