RETREAT REGISTRATION Name * First Name Last Name Email * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Date of Birth MM DD YYYY Are you a student at Baeside? * Yes No Please select your room type Private Standard Shared Standard Private Superior Shared Superior Private Deluxe Shared Deluxe If you are booking a Shared Room with a friend, please write their name below. If not, we will do our best to match you with someone. Do You Have Any Dietary Requirements? Yes No If yes, please specify below (Vegetarian, Vegan, GF, DF, allergies, other) Emergency Contact Details (name & number) What are you most excited to achieve on your Wellness Retreat?! Please let us know if you have any questions or concerns. We can't wait to retreat with you! Thank you!
