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?

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.

Would you like to receive my email newsletter?

Yes - Please

No - Thank you

I already receive it

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.

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

Participant Deposits, Cancellations Info, Waivers and Agreement. Please review this document: https://docs.google.com/document/d/1J5YEvwP973tPSk8UJVi8rjLG59u4oOH4joXZ13OjeMo/edit?usp=sharing

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.

⁠I have read and understood the policy but I have some constraints. I would like to discuss these with the retreat leader.

What would you like to gain from this retreat?

Anything we should know?

contact me e: kara@reshapemidlife.com P: 719-286-9177

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