Retreat Intake Form

First and Last Name*

What is the name that you go by?*

Have you ever been to an event or a workshop with Elissa?*

Where are you lodging during your visit?

Do you have any food allergies?*

Do you have any medical conditions that require special accommodations?*

Are you taking the class with a friend? Please put their name here if you would like to be seated with them.

Do you need to make rental arrangements for a machine and/or other equipment?*

Do you have any other questions about the event/location space, etc?