Slide 1

Application for Retreat – New Year’s 2023-2024

Write your full name: *

First

Last

Your cell #: *

Your email address: *

When are the best days / times to call you?

Best way to communicate? *

Where are you from originally? *

Where do you live currently? *

Address Line 1

City

State / Province / Region

Postal Code

Country

When is your birthday? *

Are you? *

Do you have children? If yes, how many and what are their ages and gender - male / female? *

What do you do for work / career? Do you like what you do? Explain. *

Why do you want to come on this retreat? List here. *

What top 5 things would you most like to get out of attending this retreat? *

What are behaviors & or habits you would like to stop & get rid of? *

Have you ever been on a personal development / wellness retreat? If so, when & where? *

Do you currently have a daily breathwork practice? If not, are you often aware of your breath and do you know the extreme importance of the breath? Explain. *

Do you currently meditate daily? If so, for how long and how many times daily? If not, have you tried and do you want to? Explain *

Do you work out regularly? How often and for how long? What do you do for your workouts? *

Do you have any injuries? Body Pain? Health concerns? Health ailments? Past surgeries? Please explain all here *

Are you happy with your weight? If not, how much do you weigh now (approx) & what do you want to weigh? *

Do you currently have a specific morning / night routine? Explain what your mornings and nights look like (routines) *

Do you have any diet restrictions / food allergies? Yes or No? Explain here your typical diet: eating patterns, restrictions, & allergies. *

Do you have specific food preferences? Explain here. *

Do you eat meat? Beef? Chicken? Turkey? Fish? Explain here. *

Do you drink coffee? How much? Do you need to consume caffeine daily? Explain here your relationship to caffeine and your needs for it *

Do you smoke tobacco? Marijuana? If so, how often? Explain. *

Do you drink alcohol or wine? If so how often? Explain. *

Are you currently taking any medications? If so, what? *

Do you take supplements daily? List what you take. *

Anyone else you want to refer for this retreat? Who? *

The retreat is 4 days & 3 nights in the Redlands / Homestead, FL on our own beautifully secluded, 5 acre property with large pool, BBQ, fire pit, 2,000 Sq Ft meditation / learning room, gorgeous grounds and lots more

Begins Friday 12/29/23 at 4:30pm & Ends Monday 1/1/24 at 10:30am

Cost includes:

• All meals and all sleeping accommodations are included - everything is included
• All workouts - activities- food - supplies
• Awesome goodie bags
• 2 - Individual, Private Coaching Sessions w/ Jolie (1 before the retreat & 1 after)

I will award ONE 1/2 off Scholarship to a lucky winner out of the applicants

SUPER QUAINT & INDIVIDUALIZED
small group and magical synergy - under 18 spots available so don't delay & sign up now 🙂

COST will be *

New Year's Retreat - $ 2,324.00
2 Payments of $1250.00 a month apart - $ 1,250.00
3 Payments of $888.00 a month apart - $ 888.00

*Once 1st payment is made - all sales are final

Square *

Card

Name on Card

Enter Coupon Code

Total

$ 0.00

Custom Captcha *