Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Emergency Contact Phone *

(###)

###

####

Meals *

UE provides simple, wholesome vegetarian and organic meals as much as possible. Unfortunately we cannot accommodate special dietary requests. If you have food requirements, please plan to bring what you need, and UE will provide kitchen access to prepare your own meals. Let us know in advance so we may place you in the appropriate cabin to avoid cross contamination.

I have celiac or other major food allergy and need my own kitchen

I plan to eat the organic, vegetarian meals with the group

Lodging *

Lodging in our charming vintage cabins, quaint off-grid yurts and enchanting campsites are provided at no charge for HB weekend retreats and Facilitator Training only. Lodging is limited and awarded on a first-come-first-serve basis when registration and payment is completed. Private rooms are rarely available, but will be considered if available, on a first-come-first-serve basis. *Please note that for RV parking there are no hookups. If attending a One-Day HB Event and wish to reserve a room, please use the "Extra Nights" purchase button to reserve your nights. Select preferred lodging:

Private Room

Shared Room

16' Off-Grid Yurt (Weather/Season Dependent)

Camping (Weather/Season Dependent)

RV Parking (Weather/Season Dependent)

Commuter

Birth Information *

Please provide your birth information (Date/Time/Town & State) *Providing your birth information will assist us in providing the most support for your breathwork sessions and data for our research combining breathwork and astrology.

MM

DD

YYYY

Do you have a past history of, or currently suffer from any of the following:

A) Cardiovascular disease, including heart attacks

B) High blood pressure

C) Severe mental illness

D) Recent Surgery

E) Past or recent physical injuries, including fractures or dislocations

F) Present or current infectious or communicable diseases

G) Glaucoma

H) Retinal detachment

I) Epilepsy

J) Osteoporosis

K) Asthma (If yes, please bring your inhaler to the workshop)

Are you currently pregnant? *

Yes

No

Have you ever been hospitalized for medical reasons? *

Yes

No

Have you ever been psychiatrically hospitalized? *

Yes

No

Are you currently in therapy or involved in any type of support group?

Yes

No

Are you currently taking any type of medication? *

Yes

No

Is there anything else about your physical or emotional status we should be aware of? *

Yes

No

Date *

MM

DD

YYYY