The Elder's Way (Bali) Survey

1

Name* This field is required.(We need your name so we know who you are!)

First Name

Last Name

2

Email* This field is required.(Best email so we can contact you as you may have found this survey via an Ad or a friend)

email@domain.com

3

Mobile Number* This field is required.(We will only use your number to let you know when we've sent important stuff!) (If outside Australia, please add your country code)

04??

Phone Number

4

What will be your age at the time of the retreat?* This field is required.(Helps us understand the mix of ages)

5

Which month would suit you to come to Bali?

July 2025

August 2025

September 2025

Sometime in 2026

6

Do you have any special dietary requirements?(We will advise the retreat of your requirements)

7

Do you have any special medical requirements?(NOTE: All information shared here is held in strictest confidence!) (We will speak directly with you if we feel this retreat may not be suitable)

8

What is your current commitment level to attend?* This field is required.(Simply so we can gain some idea of the overall numbers)

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Not sure if I can make it :-(

I will swim there if I have to! :-)