Reset Retreat Cambodia - Expression of Interest
20th Nov - 29th Nov 2025
Arriving at Bygone Boutique Hotel, Siem Reap on Thur 20th and departing on Sat 29th
Full Name
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Email
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Contact number
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Country you would be travelling from
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Dietary restrictions (please note that peanut traces are common in Cambodia)
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Physical activity restrictions (you will need to be able to walk at a steady pace for an hour at a time - no strenuous activities planned)
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I agree to conduct myself in a manner that will not negatively impact others, and at all times be culturally respectful.
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Please Select
Yes, I agree
No, I do not agree
Please note that disrespectful behaviour may result in being removed from the retreat at own expense.
I have read the Frequently Asked Questions (below) and have a good understanding of what is to be expected. NB you may need to download the FAQ to read.
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Please Select
YES
NO - **please read before submitting this form
Frequently Asked Questions
I understand I will be contacted within 3 business days of submitting this form, to discuss and finalise suitability, registration and payment options.
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Please Select
I understand
You will also be sent Terms & Conditions, and upon viewing this document you will have the option to withdraw this application.
If approved, I agree to pay the deposit of $500AUD (non refundable), within 14 days, and to pay outstanding balances by 30th September 2025.
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Please Select
Yes, I agree
No, I do not agree
Is there anything you need to know before committing to join the retreat?
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How did you hear about the retreat?
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Social Media
Friends / Family
Newsletter
Other
Signature (typed name will be considered an e-signature)
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