2023 Retreat Application

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Hosted by Autoimmune and You podcast hosts: Rachel Albo & Erika Bustos

Full Name (First & Last): *

Today's Date: *

YYYY

Phone Number: *

E-mail Address: *

Where do you live? (city, state / country) *

Age *

What is your autoimmune diagnosis / when were you diagnosed? *

How would you describe your personality? (Please be as detailed as you'd like and be honest; this does not affect your eligibility to attend. It just helps us get to know you better.) *

How did you find out about this retreat? *

Please explain a bit about your journey and what you hope to gain through attending this retreat. (This helps us get to know you a bit better) *

What about our Autoimmune and You podcast resonates the most with you? *

What is your favorite Autoimmune and You episode?

By completing this pre-application, I am not yet financially responsible and I am eligible to receive more information before committing. I do understand that if chosen to attend this retreat, this is a financial investment and I will be responsible for making 3 non-refundable payments within 6 months. The first payment is 50% of the retreat cost, which will be outlined after the official application is selected. **Signature: Please type your full name to agree** *

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