Name *

First Name

Last Name

Cell Phone *

(###)

###

####

If this is a reoccurring class? If so, how often?

Daily

Weekly

Monthly

5 Classes

10 Classes

What type of activities would you like? *

Sound Bath

Guided Meditation

Workshop

Other, please specify below

What is the ideal date for your event?

Please choose a date you'd like to have your In Studio retreat, I can not guarantee it will be available but we will start there.

MM

DD

YYYY

What time would you like your event to being?

Hour

Minute

Second

AM PM

Would you like to use Long Island Vibes' Private studio? *

located in Manorville, NY (full address given upon registration)

Yes

No, I have another location in mind, please specify below

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country