Cultivate Om Retreat Tulum Registration

*After completing registration form below, click submit. Then please click link to make payment at the bottom of the page.*

Name

First Name

Last Name

Email Address

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact

First Name

Last Name

Emergency Contact Phone

(###)

###

####

Emergency Contact Email

Relationship

Accomodation Preference

Dietary Restrictions

Vegetarian

Vegan

Gluten-Free

Dairy-Free

Nut Allergies

Fish is ok

None

Injuries, Pre/Postnatal, Special Requirements, or Additional Notes

Roommate Preferences

Please list if you would like Cultivate to pick your roommate or if you have a person you want to request to room with.

I agree to Cultivate Fit & Well Terms and Conditions (link below)

Yes

How did you hear about the retreat?

Please list if you found the retreat through an influencer or website.

Have a PROMOCODE? Add it here.