Luminous - Retreat Agreement

Luminous - Retreat Agreement

Portugal - May 23-30, 2027
Retreat and Personal Information
First Name
Last Name
Birth Date

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Country
Contact Telephone Number

Area CodePhone Number
E-mail Address
example@example.com
Passport Number
Passport Country
Passport Expiration (MM/YY)
Please ensure your passport does not expire within 6 months of the date of your RETURN to the United States
Travel Companion Name(s)

Emergency Contact and Travel Details
Emergency contact full name

First NameLast Name
Relation to you
Emergency contact telephone number

Area CodePhone Number
City / State or Province
Travel insurance company
Please note that travel insurance is required. If you choose not to purchase, Pilates Body Center is not responsible for any expenses lost due to cancelation of the retreat for any reason.
Travel insurance policy number

Health, Dietary, and Activity Disclosures
Do you have any dietary preferences or restrictions?
Dietary preferences or restrictions - details
Health conditions / medications we should know about
Health conditions / medications - explanation
Physical limitations or injuries we should be aware of
Physical limitations or injuries - explanation

Room Selection

Rooms are available as Private or Shared. Shared rooms must be booked with another attendee. If booking a private room, please select 2 spaces. If booking a shared room please indicate who you will be rooming with & make sure they book at the same time. I will reach out if there is any question or if the room choice is unavailable.
I will be sharing a room with:
If applicable
PREMIER - 2 Rooms Available - Single or Shared King Bed, en suite, with private patio, jacuzzi, kitchenette & seating area
EXCLUSIVE - 3 Rooms Available - Single Twin beds or 1 large bed, en suite, private patio
EXCLUSIVE - 1 Room available - King bed, en suite, private patio - Single only
SUPERIOR - 3 rooms available - Single Twin beds or 1 large bed, en suite, opens to common outdoor area
SUPERIOR - 1 Room available - Queen bed, en suite w/tub, opens to common outdoor area - Single only

Cancellation Policy

Your deposit and each ensuing payment for the retreat are non-refundable. By signing this waiver, you acknowledge that you understand this policy and have been advised to purchase travel insurance to protect your investment. Please note that Cancel for Any Reason Insurance must be purchased as soon as the first payment is made, should you choose this type of travel insurance. All retreats are hosted with a minimum number of participants as detailed in the Liability Release linked below in this form.

By signing below you acknowledge understanding the cancellation policy.
Signature

PAYMENT

Deposit$750.00

All deposits are to be made via credit card to secure your spot. Ensuing payments may be made via credit card, check or Venmo. Please indicate below how you would prefer your payment plan to be charged.

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

PAYMENT SCHEDULE:

Your balance, after the deposit and any previous retreat attendee discount, will be divided into 3 payments. As indicated in the cancellation pilicy above, each payment is non-refundable.

Payment 1 is due on September 1, 2026

Payment 2 is due December 1, 2026

Final balance due February 1, 2027

If registering after any payment due date, you will be charged for the previous payment. (ex: You register on Sept. 15. You will register with both the deposit and Payment 1 on that date)
Please indicate how you intend to make your retreat payments:

Agreement, Signature, and Certification
Print name
Signature
Date

MonthDayYear
Date
Should be Empty:

Luminous - Retreat Agreement

Retreat and Personal Information

Emergency Contact and Travel Details

Health, Dietary, and Activity Disclosures

Room Selection

PAYMENT*

Agreement, Signature, and Certification

PAYMENT