Language
  • English (US)
  • Application Form - Rest and Replenish for Mothers

    Myall Lakes, May 27-30th, 2022
  •  -  -
    Pick a Date
  • Health Details

    In order for us to best serve each participant on the retreat, please answer the following questions. All answers will be kept strictly confidential. 

  •  
  • I realise that retreats held by Banksia Wellness Retreats require my mental and physical health and I certify that I am fit to undertake it.

    I understand there is a $400 non-refundable deposit (unless Covid-19 related, in which case it is refundable. See T &C), and the remainder of my investment is due one month prior to the commencement of the retreat, unless other arrangements have been made with Banksia Wellness Retreats. 

    Banksia Wellness Retreats

    BSB 313140

    Acc 12284310

  • Clear
  • Thank you. 

    Our partner, Eliza Shumack, will contact you to book your place upon acceptance of your application. 

  • Should be Empty:
Jotform Logo
Now create your own Jotform - It's free! Create your own Jotform