Please complete one form for each retreat participant
Name *
Name
Address *
Address
We respect your privacy and do not share your information
Phone *
Phone
A mobile phone number where you can be reached in case of emergency during your travels
Date of Retreat *
Date of Retreat
Current availability is for the week of September 1, 2018
We will do our best to accommodate special needs and will contact you if we do not feel that we are equipped to meet such needs
Your space is reserved for the retreat upon completion of this form, signed agreement to the Terms and Conditions and payment of non-refundable $500 deposit to the PayPal account linked to the following account: https://www.paypal.me/mediterraneandiet