Pole Retreat Form | Goldy Birdy

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Palm Trees

Pole Retreat Form

Please take a moment to fill out the form.

Name & Surname (as in passport)

Birthday

Pole Retreat Location

Package Option

Code

Phone

Top/Bra Size - Choose an option

Pole Abbilities

Photos / Videos *

I give permission for my photograph to be used in social media

I give permission for my photograph to be used on website

I give permission for my videos to be used in social media

I give permission for my videos to be used on website

I don't want to appear on photos or videos of retreat

I agree to the terms & conditionsView terms of use

I read and understood pole retreat agreementView terms of use

Your Signature

Thanks for submitting!

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Goldy. Birdy.Retreats official part of Black Caviar Club Ltd Entertainment Department

Registered in England: company No. 12469958 registered VAT No.370296785

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