First Name*

Last Name*

Age*

Full Street Adress*

City*

ZIP / Postal*

State / Region*

Country*

Phone Number*

International Code Number*

Email*

Occupation*

T-shirt size:*(T-shirt details)
XSSMLXL

Where did you first hear about this retreat?*
From Grace of No Age resources directly (web page, social media, newsletter)From Chiara Cantone - Less is More platforms.From Mun Bau - Pilates with Mun platforms.Others. (Please, let us know)

Other

Emergency contact*

Emergency contact relationship*

So that we can be of service to you, what is your intention, or what do you wish to gain from our retreat experience together? *

Do you suffer from any psychological or mental condition?*
Yes (Please elaborate)No

If yes, please elaborate here:

Do you take any medication?*
Yes (Please elaborate)No

If yes, what kind of medication do you take?:

Do you suffer from any heart or lungs condition that might prevent you from exercising at any level?*
Yes (Please elaborate)No

If yes, please elaborate here:

How would you describe your physical condition:
I am super strong, I exercise regularly.I am okay. I walk sometimes and do exercise here and thereI am not fit. Really I don’t have the time or the enthusiasm to exercise.

Have you ever practiced pilates before?:
Yes, very often.Yes, sometimesNever.

Have you ever practiced golf before?:
Yes, very often.Yes, sometimesNever.

What type of food do you prefer:
I eat everythingI don’t eat meat but I eat fishI am vegetarianI am veganI am a breatharian (just kidding! but if you really are, let us know and you can get a massive discount on meals!)

Please let us know of any allergies or further requirements you need:

I agree and understand the scope of the terms and conditions
I have read and understand what is included and what is not included in the price of the retreat.

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