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.

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.

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

One afternoon during the retreat, we’ll enjoy a casual group bike ride along scenic 30A. Please let us know your preference:

I prefer a traditional cruiser bike

I'd love to ride an e-bike

I'm flexible - either type is great

I graciously decline. Bike riding isn't my thing

There’s a pool at the retreat home. If at least 3 guests plan to use it, I’ll have it heated (into the 80s). Temps outside will likely be around 70°F.

I'd love to swim or dip in the pool

I do not plan on using the pool

I'm flexible and may get in if it is heated

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?