Weekend Retreat Form

1

Retreat Date* This field is required.

17 to 19 April 2026

2

Name* This field is required.

First Name

Last Name

3

Phone Number* This field is required.

4

Email* This field is required.

example@example.com

5

Dietary Requirements

6

Accommodation * This field is required.If your first preference is no longer available we will contact you to discuss other options.

Camping $340

Loft $440

Single Room $790

Shared Room $540

Couple $1080 (for two)

7

If you are planning on coming with a friend/s OR as a couple, please let us know who you are coming with so we can allocate rooms accordingly:

9

MassageAre you interested in booking in for a Massage on the Saturday for an additional cost?

YESNO

10

Next of Kin Name* This field is required.

First Name

Last Name

11

Next of Kin Relationshipe.g. husband, sister, daughter etc.

12

Next of Kin Phone Number* This field is required.