Pure Retreats and Wellness CommentsThis field is for validation purposes and should be left unchanged.Tell us about yourselfWhat is your full name(Required) First Last Where are you fromAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Phone(Required)(We will only use it to send you new retreat dates, no other purpose and it will not be shared)Email(Required) (We will contact you with open dates and updates on acceptance into the retreat.)Do you have any passions, hobbies, interests, fun facts about yourself?What is your greatest challenge at the moment? (please elaborate so that we can assess if this retreat is right for you)What do you consider your greatest weakness?What do you currently do for work? (if you are in between careers, please share what you'd like to do)How old are you?Do you meditate? Which statement best applies to you? I meditate regularly I want to grow within my current meditation practice I would like to start meditating I do not wish to meditate Do you identify as female. The Self Love Retreat is a retreat just for women Yes No Please upload a photo of yourself.Max. file size: 256 MB. Why would you like to attend the Self Love Retreat? [select top 3 priorities] Meet my soul family/make friends for life Get to know myself & my purpose Learn how to meditate Relax & take a time out Return home feeling completely renewed from the inside out Put myself & my needs first for once Celebrate & let my hair down Do some inner work & let go of the past I need a break What are you hoping to get out of this retreat? (in your own words)Have you been on retreats in the past? (If so, please list the host company & location & type of retreat)What questions do you need answered, before committing to this experience? (let us know so that we can reply with additional info.)Will you be attending solo, with a friend, or with a group? (list how many are interested in total)If you are part of a group, please list their names below (please ensure everyone else submits their own application)What is your relationship with your group/persons? (friend; family; partner)Guests understand that sleeping arrangements are sharing a queen/king bed with a fellow sister? (We take care to match you up with someone suitable to share a room. Due to availability, we may prioritize applications from those who are open to sharing) Think Slumber Party! Yes – Got it, I am open to sharing No – I would prefer my own bed & understand I will be charged double the program rate Do you have any food allergies, intolerances, or dietary requirements we should be aware of?Do you have any physical health challenges?Are you, or have you in the past suffered from any mental health challenges? PTSD depression eating disorders OCD panic attacks/night terrors bipolar If yes, please give details.(Disclaimer: We ask in order to understand personal healing needs. We do not judge & ensure this information is kept confidential)Are you currently taking any prescribed medication? (If yes, please provide details)Do you have any phobias? If so, please provide detail.Do you experience sleep walking, snoring, insomnia or any other sleep disturbances? If so, please provide detail.Do you have any past or present addictions? Alcohol, drugs, gambling, etc.Lastly, we really want to know… What is your go-to song to feel empowered & confident?And is there anything else you'd like to tell us? Anything else before we receive your waitlist application?CAPTCHA
