IMPORTANT: Fill out this form ONLY if you have already reserved your space via bank transfer or PayPal.
1- Full Name (required)
2 - Email (required)
3 - Age (required)
4 - Nationality (required)
5 - Place where you live (required)
6 - Your profession or current activity (required)
7 - Do you speak Spanish? NopeYesA Little If you answered "a little", how much in terms of percentage?
8 - The program you will attend is: Breathing GatheringSilent RetreatIndividual SessionYour Own Retreat21 Days MeditatingBreathing WorkshopHuman BeingEaster RetreatYear-End Retreat
9 - Have you meditated before? NeverFrom time to timeYes, I have a practice
If you answered yes, what type of meditation?
10 - Have you practiced yoga? NeverFrom time to timeYes, I have a practice
If you answered yes, what type of yoga?
11 - Do you suffer from any of the following conditions: EpilepsyGlaucomaHigh blood pressureLow pressureBrain disordersHeart conditions – which one? Depression – From 1 to 10 (with 1 being the least degree), what degree? Any other condition not mentioned in this list: None of the above options
12 - Have you visited Modo Elefante before? NeverYes
If you answered yes, did you take a course or retreat?
13 - How did you find out about Modo Elefante?
14 - What is your main motivation for doing a course or retreat at Modo Elefante?
15 - Can I add your email to The Elephant Newsletter list? It is sent approximately once a month with content in the form of articles, links, photos, videos, events... YesI'm already on the listI prefer to do it myself directly from the website
16 - Anything else you would like to add?
17 - Finally: I'm Antonio, have we met before? NeverYes
If you answered yes, I would appreciate if you could refresh my memory on where and when.
Thanks. Your information will be treated completely confidential.
I'll get in touch with you soon. Pura vida!
