Retreat Registration

Legal First & Last Name:

Phone:

Preferred Name:

Email:

Business Name or Creative Alias:

(If Applicable)

Which are you?

Industry:

Home Zip Code:

Personal IG Handle -or- LinkedIn Profile

Were you referred by someone?

How do you plan to commute to the Catskills?

Is there a specific attendee(s) you wish to have as a room mate?

If you are selecting the 'Thriving Together' Package enter the following information for the person accompanying you.

What areas of your business or creative career do you find your self struggling in?

What areas of self-care do you find your self struggling in?

How did you hear about this retreat?

Why would you like to attend this Self-Care Retreat and what results do you wish to achieve?