Winter 2018 Retreat
Registration Questionnaire 
Welcome! We are so excited to have
you join us on a Be Luminary Course & Retreat.
This questionnaire officially registers you for your
retreat. It will also help us learn a bit about who
you are, what matters most to you, and how
we can best serve you.

It takes most people about 10 minutes
to complete. When you are done follow the
payment link to pay and officially
secure your spot on this life changing 

We look forward to welcoming you into our
Luminary Sisterhood!

All information is 100% confidential.
Let's Get Started
This is an investment in helping yourself shine brighter –
it's so worth every penny and every moment to take
this extremely precious time out for yourself to reset
and connect. I wouldn't miss the next one. I would do
this every year if I could! 
          - Erin G. | Filmmaker | Fall 2016 Retreat Participant

A couple of things to note as you apply:
1) Retreat dates are February 25-March 4, 2018.
2) Online pre-retreat coursework begins January 28, 2018.

2) Regular tuition is $2,850.

What's your first name? *

Hi {{answer_Uyyn}}, so nice to meet you.

What's your last name? *

What's your phone number? *

What's your mailing address? *

How old are you, {{answer_Uyyn}}? *

Your gender? *

How do you self identify?
What do you do for a living? *

Now for the fun stuff!  Let's talk a bit about
your personal history.

What's the most important thing we should
know about you right now? *

What major life transitions are you going through
right now, if any? *

For example: birth, death, marriage, breakup, job change, recent move,
health changes, etc.
What three things are you most proud of about
yourself or your accomplishments? *

What’s the hardest thing you’ve had to overcome? *

Deep breath.  We know this can be hard to summarize, but we want to
be able to celebrate your strength and resiliency with you.
What are the top 3 most important relationships
in your life right now? *

Please include their names and association with you (ie: partner, daughter,
friend, father, dog, etc.)
What are your three best qualities? *

What do you most appreciate about yourself? Go ahead, brag a little!
Are you under the care of any physical, mental or allied health professionals? *

If so, what kind of health care provider are they, and what are they helping you with?
If you had a magic wand, what 3 body or health-related challenges or concerns would you erase? *

What is your favorite thing about your body? *

If you had a magic wand, what 3 challenges or concerns in your life would you erase? *

What term do you feel most comfortable using
in conversation?

What brings you joy?  Name a few things that
make you feel fully alive and connected. *

Share with us a goal you have for: 
A) your personal life
B) your professional/public life *

{{answer_Uyyn}}, we’re so honored you’ve shared so
much with us already!

How did you hear about Luminary? *

What excites you most about a Be Luminary retreat experience? *

What are 3 things you hope to experience or
walk away with? *

You made it {{answer_Uyyn}}! That's the end of our registration questionnaire. Get ready to make the leap and join
us for this life-expanding experience.

Are you applying with a friend and want to take advantage of our FLASH BRING A FRIEND retreat sale? If so, write her full name below.

After you submit your questionnaire, hold off on paying for the retreat. We will email you within 24 hours a special payment link for the sale price. Payment is due by midnight 1/10/18.

*If you are NOT applying with a friend, skip this question, submit your questionnaire, and follow the prompts to pay for the retreat to secure your spot.
Pay for your retreat at the link bellow
and you are officially in!

P.S. Act fast! Spaces are offered on a 
first come first serve basis. We are unable
to secure your spot on the retreat until
full payment or the first installment
of a payment plan
is sent.
Pay Now To Finish Your Registration