Elemental Wisdom Retreat Registration

Dominican Republic

March 1 - March 8, 2026

First name

Last name

Email

Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

Sliding Scale Pricing Choices

Select from either the single or double room options. Refer to the Sliding Scale Pricing section of the website if you are unsure of which option is most appropriate for your situation.

Payment Options

Pay In Full

Custom Payment Plan

Pay In Full - Your payment will be due no later than January 31, 2026.

Custom Payment Plan - We will be in contact to create a payment schedule that works for you.

Roommate Request

First & Last Name

Are you interest in adding on any of the following excursions or activities?

Massage

Beach Tour

Ziplining

Whale Watching

Payment for additional excursions/activities are not included in retreat price. Arrangements can be made upon arrival at Villa Serena.

Are you interested in experiencing Santo Domingo with Kelsey & Angie on Sunday, March 8th?

This experience is not included in the cost of the retreat. If attending, your return flight should be scheduled on or after March 9th.

Do you need any special accommodations for housing? (i.e. a room on the first floor)

Dietary Restrictions/Preferences

Financial Assistance

Are you in need of financial assistance for this retreat? If so please let us know in what ways we can make this retreat more financially accessible to you.

A more detailed scholarship request is available HERE.

Retreat Scholarship Donation

$50

$100

$200

Help another access the Elemental Wisdom Retreat. All donations will be applied to current retreat participants. If you have a specific person you would like to financially assist let us know.

Emergency Contact Information

Emergency Contact

Emergency Contact's Phone

Emergency Contact's Email

Travel Information

If you do not have all of this information at hand please send it over via email to mooninscorpioyoga@gmail.com once you obtain it.

Passport Number

Travel/Medical Insurance Information

Flight Information

Include:

Flight #

Arrival & departure time to the D.R.

Health Information

Have you participated in yoga before?

Yoga experience is not a requirement for participation in this retreat. We welcome all levels of ability to our classes.

Physical Limitations

This helps to add accommodations for yoga as well as excursions and the overall retreat experience.

Are there any medical issues we should be aware of?

A full disclosure of medical history is not necessary. We ask this in case you have a medical emergency. We will keep this information private and only disclose to a qualified health professional if necessary.

Let us know any questions or comments. Looking forward to retreating with you!

Acknowledgement & Payment

I understand that I must book and pay for my own flight.

I understand that I must pay the $500 deposit upon registration and pay the remaining balance no later than January 31, 2026.

Retreat Deposit

$500

A non-refundable $500 down payment is due at the time of registration. We will invoice you for the remaining balance. Check your email for registration confirmation and invoice request. The remainder of your payment is due no later than January 31, 2026.

If you need to change your accommodations or housing preferences before the start of the retreat please reach out to us. See the cancellation policy on the website for more details.

Moon In Scorpio

Yoga Movement MFR