Name *

First Name

Last Name

Phone *

(###)

###

####

Location of Event *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Desired Date (if known)

MM

DD

YYYY

Desired Start Time (if known)

Hour

Minute

Second

AM PM

Desired End Time (if known)

(3 hour Minimum per Therapist)

Hour

Minute

Second

AM PM

Would you like us to include a gratuity in your quote? *

No (Attendees will tip)

15%

20%

25%

What event frequency / frequencies are you interested in? *

Select all that apply

One-Time Event

Quarterly (5% Discount)

Monthly (10% Discount)

Weekly (15% Discount + Loyality Perks!)

Corporate Residency (20% Discount + 6 x the Loyality Perks!)