Women In Leadership Retreat Survey Form

Women In Leadership & Wellness Retreat

We are delighted to inform you that Mind Body Moms is planning to offer a Women In Leadership Retreat next year.

Whether you are a full time manager, a full time mom, a full time working mom, or community volunteer organizer, we value you as female leaders. We see the value you bring to your teams, families and communities, and we want to invest in you as leaders! We would love to serve you with our leadership and wellness retreat next summer, and would love your input so we can craft a truly engaging experience, with you in mind!

Please fill out this questionnaire to help us serve you best:

Name*
First Last
Email*
Email Again*
1. What kind of a leader are you? (Please identify all that apply)*
- Corporate leader / manager (or want to be one day)
- Chief Emotional Officer of your family or Co-Director of your family (or want to be one day)
- Entrepreneur / small business owner (or want to be one day)
- Non-profit leader (or want to be one day)
- PTA / PTO leader (or want to be one day)
- Public Service leader (or want to be one day)
- School Board leader (or want to be one day)
- Community volunteer leader (or want to be one day)
Other:
2. Would you be interested in a leadership development retreat that also incorporates wellness-oriented activities?*
- Yes
- No
3. If yes, what kinds of wellness activities would you like most:*
- Mindfulness training
- Meditation
- Compassion practices
- Self Compassion
- Gentle Yoga
- Active Yoga
- Beginner’s Yoga
- Learn to Surf
- Surfing
- SUP (Stand Up Paddleboarding)
- Hiking
- Bird Watching
- Cooking classes
- Dance class
- Tai Chi / Qi Gong
- Massage / spa
4. What type of development are you looking for on this retreat:*
- Parent Leadership Training
- Basic Leadership Training
- Leading & Managing with Mindfulness & Compassion
5. Since many of the women we work with are moms, we are considering offering a “Young Leaders Retreat” (ages 15-21) that coincides with our Women In Leadership Retreat, so women can bring their teens and young adult children (all genders welcome) for an enriching experience, and have a fulfilling and informative “family experience” together in the summer. Would you be interested in this additional “Young Leaders” component?*
- Yes
- No
6. If yes, please let us know how old your teens / young adults are. Please simply list ages like this: 16, 21:
7. Since many moms of younger children have a hard time leaving their children at home for a week, we are also considering offering a “Kids Outdoor Education Camp” (ages 6-15) that coincides with our Women In Leadership Retreat, so women can bring their kids (all genders welcome) for an enriching experience, and have a fulfilling and informative “family experience” together in the summer. Would you be interested in this additional “Kids Outdoor Education Camp” component, so you can bring your kids?*
- Yes
- No
8. If yes, please let us know how old your kids adults are. Please simply list ages like this: 8,12:
9. We are planning to offer a week-long retreat in the summer, during the week of July 4, so people can have at least one day off of work during the retreat. Do you like this timing?
- Yes
- No
10. If no, please let us know why, and what your preference is:
11. We are also considering offering a retreat during Thanksgiving week 2019. Would you be interested in a Women In Leadership & Wellness Retreat that week?
- Yes
- No
12. If yes, please let us know which locations you would like to travel to during that week (Check all that apply):
- Select All
- Brazil (lovely retreat center, great food, surfing, hiking, waterfalls, whitewater rafting, cultural experience)
- Thailand (lovely retreat center, great food, snorkeling, cultural experience)
- Bali (lovely retreat center, great food, surfing, cooking, incredible cultural experience)
- Hawaii (lovely NEW retreat center, family-friendly, amazing Farm-To-Table food, surfing, SUP, snorkeling, zip-lining & more!)
- Mexico (lovely retreat center, great food, surfing, Close, very easy to get to, and VERY affordable flights)
- California (within 3 Horus from Silicon Valley, close, easy to get to, and no flight or VERY affordable flights for most of us)
13. If you checked “California”, would you prefer a weekend retreat close to Silicon Valley (within 3 hours) instead of a full week? Check all that apply:
- Weekend
- Long Weekend
- Week
14. Any additional thoughts you have would be so helpful for us. Tell us what you think!
15. Would you like to be added to our newsletter so you can be informed of our upcoming retreats?*
- Yes
- No
- I already subscribe to the newsletter
16. If yes, which newsletter would you like to subscribe to:*
- I am a parent and would like to receive information about retreats as well as family-oriented wellness offerings
- I only want to be informed about retreats. Please don’t send me information about monthly wellness offerings for moms and families.

Thank you SO MUCH for giving us some feedback, so we can create a truly nourishing and beneficial experience for YOU!

Please make sure you subscribe to our newsletter so you can be the first to be informed when we offer the retreat!

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Yesterday was especially healing and grounding. I truly felt peaceful, loved and empowered. I feel so blessed to have found you, Jackie and all the lovely women in our circle. Thank you so much all the love and support yesterday and always.

Miriam H. from Palo Alto, 2017

I have to tell you that I draw from the lessons I learn in our moms group several times a day. Everyday. What we’re learning here is invaluable.

Anu B., 2016

I can honestly say that I'm a better mom, wife, sibling, daughter, and person this year because of this group.

Alison L., 2014

I am constantly humbled by the depth of vulnerability and courage in this circle. Our stories, the laughter and tears, the familiar nods when another Mama is sharing, the brilliant questions and wise answers offered....it all is truly amazing. Like waves we rise together in joy, and fall together in heartache, each of us returning to the same ocean of experience. Thank you for this circle.

Kaveri P, 2014

I consider it one of the biggest gifts I have received, to have found you and our amazing circle of moms.

Asawari A., 2016

Women In Leadership Retreat Survey Form

Women In Leadership & Wellness Retreat

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