JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Italy Retreat Application
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Name (first, last)
*
Your answer
Email Address
*
Your answer
Phone Number
Your answer
Date of Birth
MM
/
DD
/
YYYY
Will you be traveling alone?
*
Yes
No
I don't know yet
What room accommodation are you most interested in?
*
Triple Room
Single Room (two twin beds)
Double Room (one full bed)
Master Suite (one full bed + twin or couch)
If you are traveling with someone, please list their name(s) below.
*
Your answer
Please explain your interest in this retreat.
*
Your answer
Do you have an existing yoga/meditation practice?
*
Yes
No
Do you have any questions we can answer for you about this retreat?
*
Your answer
All participants are subject to a background check. If selected to attend this retreat, are you agreeable to this? (We want all of our students to feel as safe as possible while on this retreat).
*
Yes
No
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Shanti St. Louis.
Report Abuse
Forms
