Name *

First Name

Last Name

Preferred Name (if different)

First Name

Last Name

Phone Number *

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Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Name *

First Name

Last Name

Emergency Phone Number *

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Accommodation Preference *

Please select your preferred room type:

Single Room

Double Room

Dietary Needs *

Select all that apply:

Vegetarian

Vegan

Gluten-Free

Dairy-Free

Nut-Free

Low-Sugar

No Seafood

None

Other

Pre-Retreat Zoom Connection Call *

Before we gather in Baja, you’ll be invited to a short live Zoom call to: - Set intentions - Meet fellow guests - Begin weaving the threads of your retreat journey When are you typically available?

Weekday Evenings

Weekend Mornings

Weekend Evenings

Other

Your Time Zone

Optional Add-On Experiences *

(Additional Fee Applies) Are you interested in any of the following extras? We’ll follow up with pricing and scheduling based on interest.

Surf Lesson

Massage

Tarot Card Reading

Retail Therapy in Todos Santos

Session with a Local Shaman

Other

Agreement & Signature *

Please confirm your agreement by checking the box and signing below:

I have read and agree to the retreat policies and guidelines.