Full Buck Moon Retreat Sign-up First Name *Last Name *Birthday *Email Address *Phone *WhatsApp NumberWe use WhatsApp (a free international messaging platform) for communications as we get close to the retreat and at the retreat. You can download it for free from IOS or Google/Android. Or visit: https://www.whatsapp.com/Street Address *Apartment, suite, etcCityState/ProvinceZIP / Postal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemen Arab Rep.Yemen DemocraticZambiaZimbabweDietary Preferences/AllergiesHow did you find out about this retreat?What do you hope to gain from this retreat?Is there anything else you want to share with me?Participant Deposits, Cancellations Info, Waivers and Agreements *IMPORTANT: I agree to the terms, conditions and waivers in the link below including that DEPOSITS ARE NON-REFUNDABLE (FOR ANY AND ALL REASONS), and the COVID-19 notice and assumption of riskClick here for the Yoga Retreat WaiverRetreat Guidelines *I understand this retreat is for people 16 years of age and older (unless otherwise permission given) and that no animals are permitted on sites (including service or emotional support animals)Emergency ContactNameEmail AddressPhoneAccommodationsChoose your preferred accommodations. Checking this box does not guarantee your reservation. Accommodations are first come, first serve, and your spot is reserved upon payment of deposit.Rooms *Bunk House: Top $1,199Bunk House: Bottom $1,299Moon Dancer Vintage Trailer: $1,699King Yurt: $1,799Container Villa Suite 1: $1,899Container Villa Suite 2: $1,899Tranquility Cabin: $1,999Serenity Cabin: $1,999Additional Guests *YesNoHow many additional guests?Additional ActivitiesThese are optional additions to enhance your experience.Choose any activities that interest you!Intentional Candle Making: $45/personHorseback Riding: $55/personApiary Tours: $6 DonationMassage: $125/personSonic Shower: $25/personSound Therapy Session (30 minutes): $40Sound Therapy Session (60 minutes): $80 Sign up!Please do not fill in this field.
