EMERGE wellness retreat

Sept 19-21 | Dickson, Tennessee

First Name *

Last Name *

Age *

Email *

Phone *

Where are you joining us from?

Address *

City *

State *

Room Choice *

Attending with a friend?

If applying for a shared option, please include the first and last name of the attendee you are sharing with.

*Each registrant will need to apply individually

Names

How do you prefer to pay?

Pay in full

Payment plan (2 payments)

A little about you:

Do you have any food restrictions or allergies? *

Do you have any physical, mental, or other conditions that may interfere with your ability to participate safely in the retreat or in the yoga, hiking, meditation or any other activities that we will do at the retreat?

e.g., pregnancy, diabetes, anemia, knee problems, back pain, asthma, hearing or seeing impairment, heart condition, inactivity, medication, PTSD, claustrophobia, medications, food allergies or sensitivities, etc.? *

What do you hope to get out of this retreat? *

Any other comments or questions? *

How did you hear about us?