Retreat Registration of Interest Form

Registration of Interest Form
Welcome and thank you for your interest in our upcoming Bali Retreat!

By completing this form, you get to be the first to know when the date has been set for 2025, before it is announced to the public.

We can’t wait to share the details with you!

** Please note, all information provided below is completely confidential and will not be used for any other purposes **
Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Email *
example@example.com
Contact Number*
How did you hear about this retreat? (please select all that apply)*

Boho Buddha Wellbeing / JoSparkling Lotus Healing / LeanneSocial mediaBoho Buddha Wellbeing websiteFriend (please provide below)Other (please provide information below)
If you selected 'Other' or 'Friend', please provide additional information below
Have you been to Bali before?*
What inspired you to enquire about / drew you to our retreat?*
What are you looking to get out of this retreat?*
PLEASE NOTE, THIS IS AN EXPRESSION OF INTEREST FORM ONLY AND DOES NOT ENTER YOU INTO ANY FORM OF LEGAL CONTRACT.

This form is only an expression of your interest and enables you to be the first to know the confirmed dates, prior to the retreat being advertised to the general public.

It in no way enters you into any form of legal contract or agreement.

We look forward to hearing from you,

Jo & Leanne.
Date*

DayMonthYear
Date
Retreat Contact List*

Yes, add me to this list.
Should be Empty: