Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Have you ever been on a Yoga, Sup Yoga or any “retreat” before? *

Yes

No

Do you have one or more movement modality practices? 

Yes

No

Are you a movement professional?  *

Yes

No

How did you hear about our LiquidRoots™ Adventure Retreat? *

Social Media

Website

Friend

Other

How would you evaluate your health? *

Some Challenges

Good

Excellent

Do you have any physical or medical conditions we should know about?  *

Yes

No

Do you have any dietary restrictions: *

No

Yes

Gluten Free

Vegetarian

Vegan

Which of the following describes your swimming ability and or comfort level in water best? *

Beginner

Intermediate

Advanced 

Have you ever been to Portugal and/or the Azores? *

Yes

No