Bali

Full Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Emergency Contact Name

NameNumber
Medical History
Please let us know any additional information we may need to know regarding your time with us & Why you would like to join us on this retreat?
Have you been diagnosed with any of the following:

Anxiety Disorder or Panic AttacksAsthmaDiabetesEating DisorderEpilepsyFaintingRespiratory ProblemsOther
If not stated above please list here:
Please let us know of any dietary requirements:
Preferred Accommodation Type

Private Room & Private BathroomShared Room & BathroomAny of the above
CANCELLATONS/REFUNDS
All deposits are non-refundable.

Cancellations made after Aug 11th 2024 and all payments made up until then are non-refundable. If you cancel before Aug 11th all payments are refundable except your initial deposit.

If you are unable to attend this trip but want to sell your space on, we accept name changes made on your behalf, however we will not be responsible for managing payments for third parties.

All payments for this retreat must be completed by Aug 11th.
Should be Empty: