Form

Modules 1 & 2 Destination Retreat
Costa Rica: February 11-16, 2026

First name*

Last name*

Email*

Mobile phone number*

PRIVATE ROOM [only 2 rooms available]

SHARED ROOM [will have individual bed]

Coming with a friend? Let us know if you'd like to be in the same room.

Emergency Contact (Name and Phone Number)*

What healing intention do I most want to set for myself?

Payment link*

Full Payment [PRIVATE ROOM] - $7777.00 | Modules 1 and 2 Destination Retreat June 2025

Full Payment [SHARED ROOM] - $6,333.00 | Modules 1 and 2 Destination Retreat June 2025