SIMPLICITY RETREAT APPLICATION Name * First Name Last Name Phone * (###) ### #### Email * Birthdate * MM DD YYYY Mailing Address * Address 1 Address 2 City State/Province Zip/Postal Code Country What is the ideal length of retreat for you? * 5 Days 7 Days 10 Days 10 Day Women's Group Retreat In which location are you most interested in going on retreat? * St. Croix, USVI Clearwater, FL Other What do you desire to achieve or gain from this retreat experience? * Please be HONEST and as specific as possible. Are you looking for a ceremonial experience or vision quest within the retreat? * Are you interested in fasting/cleansing/detoxifying within this retreat? * Do you have any physical, mental, or emotional limitations that you need your retreat team to be aware of? * Do you have any specific needs that require special care that the retreat team will need to be aware of? * How many people will be coming with you on retreat? * Is there anything else you would like to add here? Please affirm that you have read the full cancellation policy and terms. * Yes Thank you for your dedication to personal transformation & willingness to invest in your life experience! Please text Mary to let her know you have sent your application and would like to find time to discuss retreat options. Mary VanceText or Call: 517-304-8066www.maryvancelifestyle.com*** Now, please submit the coaching intake you will find on the programs page. This will inform Mary & her team about your dietary needs and personal goals. *** Please review our cancellation policies and retreat terms here.
