Intimate Reconnections, LLC

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Partner's First and Last Name:
Partner's First and Last Name:
Preferred Email Address:
Preferred Phone Number:

Which date/location are you interested in?

Phoenix, AZ, October 23, 2008 to October 26, 2008
The Boulders Resort and Golden Door Spa (4-star)

Port Antonio, Jamaica, February 2009
Hotel Mocking Bird Hill (eco-lodge, 3-star equivalent)

Please make a suggestion for a future retreat!

Tell us about yourselves:

Partner 1:

Partner 2:

Tell us about the positives in your relationship:

Partner 1:

Partner 2:

Tell us about the concerns in your relationship:

Partner 1:

Partner 2:

Tell us about your goals for the weekend:

Partner 1:

Partner 2:

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