Please complete one form for each retreat participant

Name

First Name

Last Name

Address

We respect your privacy and do not share your information

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

A mobile phone number where you can be reached in case of emergency during your travels

Country

(###)

###

####

Email Address

Date of Retreat

Current availability is for the week of September 1, 2018

YYYY

Price of Retreat

If Double Occupancy, name of travel partner if known (if not known, please indicate gender and a roommate will be assigned to you accordingly)

Special Needs, Additional Comments and Discount Codes

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

Congratulations! The first step in your registration for the Mediterranean Life Wellness™ Retreat is complete!

Step 2: To reserve your spot, please download the Terms and Conditions Form, initial each page, fill in the requested information and sign. This form should then be scanned and emailed to mediterraneanliferetreats@gmail.com.

Step 3: A $500 non-refundable deposit is your last step to registration. Please go to paypal.me/mediterraneandiet in order to place your deposit with mediterraneandietforcancer@gmail.com and make your registration official!

We are looking forward to welcoming you!

Thank you!

Mediterranean Life Wellness™ Retreats