Siesta Retreats Application
Name
*
First Name
Last Name
Name of partner if attending as a couple
First Name
Last Name
Phone Number
*
Email
*
I agree to the terms and conditions outlined in the participant expectations below
*
I agree to retreat participant's expectations
Signature
*
Date
-
Month
-
Day
Year
Date
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Choose your siesta!
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Individual Package
€1,500.00
€
1,500.00
Quantity
1
2
3
4
5
6
7
8
9
10
Couples Package
€3,000.00
€
3,000.00
Quantity
1
2
3
4
5
6
7
8
9
10
Wellness Upgrade
€400.00
€
400.00
Quantity
1
2
3
4
5
6
7
8
9
10
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
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Expiration Month
Expiration Year
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2033
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Expiration Year
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