Women’s Retreat Registration 

Name

Email Address

Phone Number

Date of Birth (optional)

Home State

Best time for a weekday phone call: Best time for a weekday phone call: 9 AM - 11 AM 11 AM - 1 PM 1 PM - 3 PM

Lodging Preference Lodging Preference Missions House Lodge Ensuite Room ( $1650 per person) Studio Cottage ($1899 per person) Other

If Other, please specify

Allergies/Food Preferences Allergies/Food Preferences No Food Preferences or Allergies Vegetarian Vegan Gluten Free Dairy Free Nut Allergy Other

If Other, please list

Would you be interested in extending your Chautauqua stay after the retreat ends? Would you be interested in extending your Chautauqua stay after the retreat ends? Yes Maybe No

What is your yoga experience level? (All experience levels are welcome!) What is your yoga experience level? (All experience levels are welcome!) Beginner Intermediate Advanced

What is your hiking experience level? (All levels welcome!) What is your hiking experience level? (All levels welcome!) Beginner Intermediate Advanced

Have you been on a retreat before? Have you been on a retreat before? This is my first retreat of any kind This is my first women's retreat, but I have been on other types of retreats I have attended other women's retreats

T-Shirt Size T-Shirt Size Women's Small Women's Medium Women's Large Women's XLarge

If Other, please specify

What is your favorite dance song?