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 selected a shared accommodation and have a preferred roommate, please enter their name below. If left blank, you’ll be thoughtfully paired with another wonderful guest.

If you were referred by a friend? If so, let us know who we can thank!

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

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

Will you join us for the included Fredericksburg outing? This full-day trip includes wine tasting, lunch on your own, and time to explore town.

Yes I plan to participate and would love to join the group

No I plan to enjoy a rest day at the ranch instead.

What is your level of yoga experience?

Beginner

Intermediate

Experienced

Would you be interested in upgrading to one aerial yoga class for $25? Yoga is included throughout the retreat. Aerial yoga is optional, with only 8 spots available.

Yes

Maybe

No

Would you be interested in booking an onsite massage during the retreat? (60 minutes for $120 (plus gratuity). This is not a commitment, just to gauge interest

Yes I'd love a massage

Maybe - I'll decide later

No thank you

Are you interested in a small group 45-minute scenic horse back ride around the ranch for $60?

Yes I would

Maybe

No thank you

Would you be interested in an optional 1.5–2 hour skeet shooting class? $65 per person – includes firearm use, ammo, and safety gear. (Limited spots available.)

Yes I am interested

Maybe but I would like to learn more

No thank you

Would you be interested in a 1.5–2 hour creative optional welding class using horseshoes? $65 per person – all materials and safety gear provided. (Minimum 3 participants required.)

Yes count me in

Maybe but I would like more information

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?