WEAVING OUR LIVES APPLICAtiON FORM

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Phone

Country

(###)

###

####

What sparked your interest in attending this retreat?

Have you attended a BodySoul Rhythms® program? If so, which one(s) and who were your facilitators?

Describe your background with Jungian analysis or therapy.

Are you working with an analyst or therapist right now or do you have access to one?

Please describe your Body Work experience (i.e. yoga, dance, authentic movement, SE, TRE, Feldenkrais, etc.)

Are you familiar with dream work? Do you have a Dream, Meditation, or Mindfulness Practice right now?

If I am accepted, I prefer

A shared room/double occupancy

A semi-private single room for an additional $500 for six nights.

Are you interested in finding a roommate?

Yes

I will have a roommate who will apply for the retreat. Please add their name.

My roommate and I prefer

One Bed

Two Beds

I am fully vaccinated and have my Covid booster

Yes

Agreement

Applications are not transferable. All cancellations must be made in writing and received by February 1, 2023 for a full refund less a $200 processing fee. There is NO REFUND for cancellations received after this date. In the event that the program is sold out with a waitlist and we are able to transfer your registration to someone on the waitlist, we will issue you a refund less the processing fee. If you leave the program for any reason, there is NO REFUND for unused services. If the program is cancelled or postponed by us, due to enrollment level or other unforeseeable circumstances, all fees will be refunded in full. If the program is cancelled or postponed, we assume no responsibility for participant’s cancelled air tickets or other prepaid transportation arrangements. By applying for this retreat, participants specifically waive any and all claims of action against Jean Palmer-Daley, Nancy Romig, Vernessa Foelix, Joan Abraham, Toni D’Anca, and Truchas Peaks Place for damages, loss, injury, accident, delay, or death incurred by any person in connection with the program. No responsibility is accepted for losses or expenses due to sickness, weather, strikes, wars and/or other causes. In the event it becomes necessary or advisable for any reason whatsoever to alter the schedule or arrangements, such alterations may be made without penalty. If the program is cancelled or postponed by us, due to enrollment level or other unforeseeable circumstances, all fees will be refunded in full. If the program is cancelled or postponed, we assume no responsibility for participant’s cancelled air tickets or other prepaid transportation arrangements. I HAVE READ AND AGREE TO THE TERMS AND CANCELLATION POLICY FOR THIS PROGRAM.

Yes

Signature

Date

Upon completion of the application form, add any additional notes below and click SUBMIT. Thank you.