The Phoenix Immersion Retreat Portland Application
Hello! We are so glad you're here and excited for the opportunity to share in the stunning beauty of Portland, Oregon with you at The Phoenix Immersion Retreat, from September 14th-17th OR November 16th-19th, 2023. Please fill out this short application and we will contact you soon.

If you have any questions please contact Andrea Firpo by email at andrea@andreafirpo.com or by phone at 415.300.5848
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Email *
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First Name *
Last Name *
Phone Number *
Address *
City, State & Country *
If you would like to be contacted by Skype or What's App please leave your contact info here.
How do you prefer to be contacted? Please check spam folder if you select the email option. *
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If you have an Instagram account, please share your username here.
I am open to anyone who is interested in this Retreat. How would you like me to identify you? *
Age
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How did you hear about our Portland retreat? Select all that apply. *
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If you were referred, please let us know who referred you?
Will you be joining with a friend, partner, or child?
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Are you interested in carpooling?
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Have you worked with Andrea, Danielle, Graciela, Sara or Jeremy in the past?
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What would you like to receive or experience in our time together? *
Which activities are you looking forward to? Check all that apply.
What are some of your personal interests and hobbies?
In one word, how would you express your dominant or primary emotion that you are feeling right now? ( fearful, burdened, trapped, limited, unhappy) *
Will this be your first destination retreat? *
Our hearts are happy to share many of our gifts and services throughout the retreat. Which of the following have you experienced in the past? *
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We will prepare delicious vegan / vegetarian lunches. Are you strictly vegan? Do you have any food allergies or dietary restrictions we should know about? *
If we were to stock your favorite refreshments, chocolate, and snacks what would those be? Be specific! (ie. trader joes peanut butter pretzels) *
The investment is $2,275 and due in full prior to the retreat. You can  also submit your deposit to reserve your spot now or after a follow up call / email with Andrea. What deposit works best for you? *
I acknowledge that all payments are nonrefundable. *
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Ready to commit to yourself and the group? Awesome! Secure your spot through payment at www.andreafirpo.com/portland
If you have any immediate questions please email Andrea at andrea@andreafirpo.com. You may contact Andrea by phone at (415) 300-5848.
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