2023 Shamanic 3 Day Retreat Registration

2024 Bali Cultural & Wellness, Ladies Retreat Registration Form

Sunday the 11th of August -Monday the 19th of August (8 Nights) Payment is NOT required with this registration you will be sent an invoice to your phone or email.
Attendee Name

First NameLast Name
Preferred Name
Birth Date

MonthDayYear
Address

Street Address

Street Address Line 2

CityState

Postcode
Attendee Email
example@example.com
Mobile Number
Emergency Contact Person

NAMEPHONE NUMBER
Do you have any Special Dietary Requirements?
Do you have any Medical or Mobility Issues we Need to Know about?
Provide further information here!
Please tell us your main reason for wanting to attend our retreat.
How did you hear about the retreat?
Your package includes Accommodation in House Meals, all entry fees to all scheduled activities, massages, sound healings. Participation in the Kesehatan wellness program. Air-conditioned transport to and from activities. Fruit and drink on arrival, and wellness program pack.

(share room Package) Retreat Villa shared with one other person Deposit $200pp Balance $1695.00ppPrivate Accommodation (Retreat & Accommodation Deposit $200) Bal $2095
Do you understand that organizing a flight to and from Bali will be your responsibility? and is not included in our price?

Yes
Do you understand that it is your responsibility to apply for your visa and check any vaccinations that are required to enter Bali?

Yes
Do you understand having your own travel insurance will be required for you to attend?

yes
Have you travelled to Bali before?

YesNo
Would you like us to call you before sending the invoice to answer any questions you may have?

yesNo
Should be Empty:

2024 Bali Cultural & Wellness, Ladies Retreat Registration Form