RetreatPartnerApplication - Dragonfly Healing Center

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Retreat Partner Application
Please complete all of the items on this form (in one session, as your input will not be saved until you submit). Thank you!

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Why do you teach? *

What do you teach? *

What services/products do you offer? *

Select what you currently have: *

Community Followers Clients Social Media Presence Mailing List Networks Marketing Partners/Affiliates Website

What is your website, if you have one? *

If you currently have clients, what are they like? *

Are your current clients your "ideal" clients? *

Yes! Nope! No clients right now...

Why do you want to create a retreat? *

What kind of retreat do you want to create? *

What is your time frame for creating this retreat? *

If you have decided on the location for your retreat, please enter it here: *

What are 3 words that best describe your retreat? *

Anything else you would like to share? *

Submit

Thank you!
You will receive a follow up very soon!

P.O. Box 812 Kihei, HI 96753

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