Register Radly

First Name

Your preferred name, your Highness.

Last Name

This is just for us. The creepers.

Email Address

This is where your ticket will be emailed, fam.

Phone Number

This is only for emergencies. We don't want to talk on the phone, either.

Emergency Contact Name

Just in case you decide to have your first allergic reaction or something else super fun.

Emergency Contact Relation

Just so we know who we are dealing with.

Emergency Contact Phone Number

Dietary Restrictions

Dish. We want you to enjoy your day!

Mobility or Accessibility Needs

Keep in mind: gentle yoga is part of the retreat so let us know if we need to modify anything.

Why the Rad Retreat

Is it because we are super cool? We get it.

What are you hoping to gain from this experience?

Where did you hear about The Rad Retreat?

Have you practiced yoga before?

YesNo

Even once is practice.

Do you have any medical conditions or concerns we should be aware of?

What are your favorite songs at the moment?

I agree to the waiver (required)

This can be found at www.spiritualitywithsam.com/group-programs/rad-retreats.

Terms & Conditions (required)

I agree to the Terms & Conditions

This can be found at www.spiritualitywithsam.com/group-programs/rad-retreats.

I agree to the Privacy Policy

This can be found at www.spiritualitywithsam.com/group-programs/rad-retreats.

Please avoid sharing sensitive data such as passwords or credit card info in this form. This is not a secure login or billing page to share that data.