Application Form – Greece Retreat

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Application Form – Greece Retreat

Application Form: A Sacred Journey to Ikaria Greece

July 2023 with Andrea Quast-Mortello

Name *

First

Last

Address *

Email *

Phone *

Date of Birth *

Emergency Contact *

Emergency Phone *

Do you have a website address that you want to share with us?

Rooming Details

Note: Retreat rates are based on single occupancy.

Are you coming with a partner or friend that you want to room with? *

Is there anything else you think that we should know about you that would be helpful in assigning you a roommate?

Physical Limitations

Please list any limitations you may have. There are a few optional hikes that you would need to be in good shape for. And a walk down to a beach with has steps but is steep.

Allergies

Other medical considerations

Do you carry an epi pen? *

Do you have physical limitations? If so, please list below. *

Can you swim? *

Additional Questions

Please take a few minutes to answer the following questions:

Is there anything else you think we should know about you?

1) What draws you to this retreat? What do you hope to get from it? *

2) Are there aspects of yourself that you would like to discover or bring to light? *

3) What are your aspirations and goals for personal transformation? *

Application Form – Greece Retreat

Rooming Details

Physical Limitations

Additional Questions

Andrea Quast-Mortello, LCSW, SEP

Licensed in NY and ME

Maine Office