Wellness Goal Inq.

Sky's the limit

* Indicates required field

Name *

First

Last

Email *

Phone *

Address *

Line 1

Line 2

City

State

Zip Code

Country

What are the goals of your Wellness Vacation? *

Weight Loss Learning how to eat clean Learn how to cook healthy Start a fitness routine Stress management

CHOOSE ALL THAT APPLY

How many people ? *

How long do you wish to stay ? *

If Other please specify: *

What type of resort are you looking for ? *

Secluded Meditation Classes Non alcoholic Full service spa United States Location International

CHECK ALL THAT APPLY

Food / Diet Requirements ? *

VEGAN ORGANIC KETO VEGETARIAN PALIO NONE

Other Please Specify *

Other *

Do you require an Onsite Doctor ? What kind ? *

What is your Budget? *

Less than $3,000 $3,001 - $5,000 $5,001 - $8,000 $8,001 - $10,000 $10,001 +

Anything else you wish to mention *

I agree to receiving marketing and promotional materials *

Submit

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