Intake Questionnaire — Inner Landscape

Thank you for your RSVP to the Inner Landscape Experience.

In the event that spaces are not available, please proceed with this questionnaire, and you will be included on a waiting list.

Cost of the experience:

5000czk / 200EUR per person
Discounts are available for groups, friends, referrals and those whose financial limitations might prevent them from joining the experience.
Your RSVP will be confirmed once a deposit of 50% or more is received
To provide meaningful feedback on the full experience with the purpose of preparing Inner Landscape for public launch
To be photographed and for your photos to be included in the gallery, used on social media and for marketing materials
For your Inner Landscape visualization to be included in the gallery, used on social media and for other marketing materials

Please view the 4-course menus for upcoming Inner Landscape experiences here. Prepared by Chef Jan Kokeš.

Name

First Name

Last Name

Confirm the email used in your RSVP

Phone

This phone number will be used to form an Inner Landscape Cohort on WhatsApp

Country

(###)

###

####

Dietary restrictions or preferences

Please indicate if you have any dietary restrictions or preferences, so that we may prepare a menu that best suits you:

Allergies to cats/dogs

Lollipop the cat and Fiona the dog both live at the Prague location of the Inner Landscape experience. Please indicate :

Event transportation from city center:

Please confirm if you would like to be included in a car pool for your cohort from the city center, at no additional cost to you:

Yes, I will join the transportation from city center

No, I will arrange my own transport

Photography and marketing

Do you give permission to being photographed during the event and for those photos to be used on the event website and/or social media channels:

Yes

Yes, with restrictions. Let's discuss.

Improvement goal

If you could get better at one thing – the One Big Thing that would make the biggest difference to you, what would it be? Now Ask yourself: Is this really true for me? // Does this implicate me? // Can I personally be held accountable for this? // Have I stated my goal in the positive? Example: I am committed to getting better at releasing my sense of personal accountability for other people's feelings, emotions, problems and issues Now ask yourself: Is there room for improvement? On a scale of 1-5, is this goal at least a 4 or a 5 in importance to me? Do I have the goal listed as an outcome? If yes, what do I need to get better at to make this happen... If you need support in forming your goal, indicate so and we'll be in touch!