Retreat Form Retreat 2024£1,444.00 — or £1,444.00 £288.80 / month for 5 months Name(Required) First Last Address(Required) Street Address Address Line 2 City County / State / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican 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 RicoQatarRomaniaRussian FederationRwandaRéunionSaint 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 TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email(Required) Phone(Required)AgePlease enter a number from 18 to 100.Time of Birth(Required) Hours : Minutes AM PM AM/PM Important for full astrology readingPlace of Birth(Required) Our kitchen witches will create a delicious vegetarian menu but please let us know of any allergies or dietary requirementsPlease answer the following questions so we can have an awareness of your needs during your stay....Do you suffer from any physical health conditions?(Required) No Yes Are you currently suffering from anxiety or depression?(Required) No Yes If yes, we have got you, just important to take into consideration with the herbs we will be using over the weekend.Are you regularly taking any medication? Such as anti-depressants, blood pressure tablets or the birth control pill? and(Required) No Yes Please give details, what for, frequency etc.(Required)Do you have the contraceptive coil fitted currently?(Required) No Yes It is not advisable to steam with the coil fitted, unless you have plans to get it removed, which I can only advise when working with the womb and on your journey back to self.Do you have a menstrual cycle?(Required) No Yes Are you entering or in menopause?(Required) No Yes When did this begin for you?(Required) Do you have a regular menstrual cycle?(Required) No Yes How many days is your cycle currently?(Required) No Yes Do you suffer from painful periods?(Required) No Yes Are you connected to your bleed? Or do you dread your bleed?(Required) Connected Dread Please tell us a bit about yourself or anything else you would like to share before the retreatBy submitting this form, you are securing your place on the Waking the Witches retreat and guarantee that the information you have provided is correct and truthful to the best of your knowledge. Mama Skye and Burning Woman Limited accepts no responsibility for any situation or accident that may arise from wrong information or failure to disclose certain conditions by the guest.Base PriceTotal Subtotal Options Total Purchase one time Subscribe for £1,444.00 £288.80 / month for 5 months Renew:Every month for 5 months (80% off) one time £1,444.00 £288.80 / month for 5 months — save 80% Qty12345 Add to basket Category: Uncategorized
