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Personal Information Form

Personal Information Form

Please complete this form and send it back to us. After we review it we'll get back to you with any additional questions or comments we may have. Our intention is to have a conversation with you to help determine if our retreats are likely to meet your needs and expectations. We'll begin this conversation by email, but at any time we're also available to have a telephone conversation.

Name
First Last
Email
Please indicate which retreat you are interested in attending:
- Summer Retreat in New Mexico
- Winter Retreat in Mexico
What is your primary reason for wanting to attend one of our retreats?
- My personal growth and development.
- To improve my relationship(s).
- To take time and reevaluate what I'm doing with my life.
- To learn better and more effective ways to communicate.
- For my professional development.
Are you comfortable being anonymous? In our retreats, participants don't use their real names. Instead, they use pseudonyms. We do this for many reasons, but one is that we want to discourage people from coming and presenting themselves based on their back home story. Do you think you'd be comfortable being anonymous for a few days?
- I'd welcome it.
- I'd rather not.
- I'm unsure.
How would you describe where you're at in your life? Tell us a bit about yourself? What challenges and opportunities do you face? What are your priorities? Do you think you hold yourself back? If so, how? What would happen if you didn't?
Do you have any concerns about attending one of our retreats? What concerns, if any, do you have about participating in a Live Conscious retreat? If you let us know, we will do our best to help speak to your concerns.
What do you hope to gain as a result of attending one of our retreats? If you are to spend a week with us and you get exactly what you want, what will this mean for you in your life? What changes do you hope for?
Pay Forward. Imagine that you participate in a Live Conscious retreat and as a result you develop healthier behaviors, better relating skills, and greater emotional maturity. How would you "pay forward"? In other words, who might benefit as a result of your growth? Maybe it's only one other person, that's fine. We're hoping that there will be a ripple effect so that our work touches the lives of more people than those who can attend our programs.
Any questions for us? If you have any particular questions for us, please let us know and we'll get back to you, usually within 2-3 days.

"When you think everything is someone else's fault, you will suffer a lot. When you realize that everything springs only from yourself, you will learn both peace and joy."— His Holiness the Dali Lama

About Us

Jake Eagle is a coach and mentor.

Hannah Eagle is an alternative health counselor.

Do you have any issues in your life or questions about your relationships? If you send them to us, we’ll give you a personal and confidential response. Contact Us »

Upcoming Retreats

7-Day “Live Conscious” Retreat
Ocamora Retreat Center, Northern New Mexico
July 9th – 15th, 2018

8-Day “Live Conscious” Retreat
Playa Viva, Mexico
Feb. 2nd-9th, 2019

We invite you to witness what what past participants have said after attending one of our annual retreats. First Hand Experiences »

Explore Our Retreats »

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