Registration Form | Reshape Midlife

First name

Last Name

Email

Phone Number

Street Address

City

State

Country

Postal Code

How would you like to handle your payment? You've already secured your spot with your $500 deposit. Choose how you'd like to handle the rest of your balance.

Stick with my $500 deposit and set up a payment plan (a $25 processing fee applies). I'll receive detailed payment plan information within the next week.

Invoice me to bring my deposit up to 50% of the total retreat cost.

Invoice me for the full remaining balance in full.

Do you have any food allergies or special dietary restrictions?

Wine, beer, water and seltzer waters will be provided at the retreat. You are welcome to bring any other beverages you prefer, alcohol or otherwise.

I enjoy white wine

I enjoy red wine

I do not drink wine and would prefer beer

I don't drink wine or beer and am fine with water or bringing my preferred beverage

My retreats are geared toward women in midlife plus. You are welcome to attend if you do not yet consider yourself in midlife, but you must be over 21. Please provide your birthday.

By registering for this retreat, you acknowledge that you will be subscribed to the Reshape Midlife email newsletter. This ensures you receive all important updates, logistics, and details related to

I understand and agree.

Please provide emergency contact info. Both name and phone number.

Do you have any health conditions or injuries I should be aware of?

What is your level of yoga experience?

Beginner

Intermediate

Experienced

If you will be attending the retreat with a friend or family member and would like to share a room, please add their name(s) in.

Would you like to add an optional in-home massage? Includes pressure customization, hot towels, aromatherapy, and a back or foot scrub (hot stones optional). 20% gratuity required, not included.

No thank you

30 minutes for 75 dollars

60 minutes for 129 dollars

75 minutes for 159 dollars

One evening is a cocktail/mocktail competition, followed by a PJ dance party. Help me design the dance playlist. Please tell me 2-3 of your favorite dance songs.

What topics would you love us to cover during Midlife Discussions? This session goes wherever the group wants. No topics off limits.

If a friend told you about this retreat? Let us know who to thank!

Participant Deposits, Cancellations Info, Waivers and Agreement. Please review this document: https://docs.google.com/document/d/1J5YEvwP973tPSk8UJVi8rjLG59u4oOH4joXZ13OjeMo/edit?tab=t.0#heading=h.cl1

A box check indicates you have read understand and agree to Reshape Midlife LLC's cancelation policy and all other policies and procedures for retreats.

Travel insurance is strongly recommended. Without it, cancellations follow the strict policy and may mean total loss of payment.

I understand and acknowledge this policy.

What would you like to gain from this retreat?

Anything else we should know?