Application to Attend the Living Authentically Retreat

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This information helps us to get to know you to see how we can serve you best. Thank you for filling it out. We look forward to getting to know you better.

Email *

What is your name? *

What are the primary reasons you would like to attend this retreat? Check as many as are applicable to you. *

I need a vacation!

The idea of being free to be myself and be authentic is appealing

I identify as LGBTQIA+ and would like to feel at ease in my identity when vacationing.

I’d love to be able to travel somewhere exotic and feel safe.

I’m looking to unwind stress

I’m ready to have some fun.

I really need to relax more.

I’m interested in snorkeling or learn how to snorkel

I am intrigued by Mayan antiquities, and or Mayan culture.

I am an LGBTQIA+ ally, and feel comfortable among people that are gender variant or sexually liberated

Other:

Required

Do you have a currently valid passport? *

Yes

Have you traveled internationally before and if so, where have you been? *

Are you currently working on trauma from recent or past events? If so, how is that affecting you and what kind of support might you need? *

How much of a risk taker are you? *

I usually like to play it safe.

I’m willing to take small excursions outside of my comfort zone.

I like to keep an open mind and be balanced about it.

Life is for a living! I like trying new things.

If you’re not living on the edge, you’re taking up too much room.

What’s your most common way to deal with conflict? *

Just keep my mouth shut and deal with it

Talk to someone about the situation.

Ask for support to manage the conflict

Cope with the conflict immediately and directly.

Do my best to deal with it, but it really does stress me out.

I am good at difficult conversations

I am very uncomfortable with difficult conversations and want to get better

Do you enjoy spending time with other people? What do you find challenging and what do you appreciate about being in a group? How much alone time is optimal for you? *

Are you in therapy? *

Yes

Have you ever been in therapy? Was it helpful?

Do you have any health issues that we would need to know about in order to make sure you are OK during the trip? If you feel comfortable sharing, could you please let us know what it is and the severity of your symptoms?

You can also tell us when we talk before the trip.

Do you have any worries or concerns that we might address before the trip? Anything else you want us to know? *

Would you like help finding the best price airfare? *

Yes

Maybe

Please be assured that your information will be kept entirely confidential, and will not be shared with any individual or business. Additionally, your information in any form or aspect will not be sold. It is safe with us. Do you have any other questions for us?

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