Registration Form | Reshape Midlife

First name

Last Name

Email

Phone Number

Street Address

City

State

Country

Postal Code

Do you have any food allergies or special dietary restrictions?

We’re encouraging a break from alcohol to support deeper rest, connection, and presence. Alcohol will not be provided, but if you choose to bring your own, please drink mindfully.

I understand that alcohol will not be provided and agree to bring my own only if I choose to drink.

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.

Would you like to receive my email newsletter?

Yes - Please

No - Thank you

I already receive it

If you selected the Shared King Suite in The Roost, please provide the name of the person you’ll be sharing the room with.

If a friend referred you, who might we thank?

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

Would you be interested in booking an onsite massage during the retreat? (60 minutes, approximately $120 — this is not a commitment, just to gauge interest)

Yes I'd love a massage

Maybe - I'll decide later

No thank you

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.

What would you like to gain from this retreat?

Anything else we should know?

1.Rooted + Radiant Retreat Week 1 August 14th-18th

2.Event Policies

Rooted + Radiant Week July 14th-18th

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