Into the Heart - Bali Retreat Registration Form

Name

First NameLast Name

E-mail

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Mobile Number

Format: (000) 000-0000.

Emergency Contact

First NameLast Name

Relationship to you

Type

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Do you have any food intolerances or allergies

Please share your allergies or intolerances here. Please type N/A if there are no known allergies etc

Please share any medical conditions here eg injuries, anxiety, pain etc. Please type N/A if there is none known.

REGISTRATION TERMS AND CONDITIONS
1. By submitting this registration form you agree that you have read and understood the registration terms and conditions and state that you accept these terms and conditions including the payment terms and conditions listed herewith.

2. Applicants must be at least 25 years of age.

3. Registration Fees and Refunds:

To secure your sacred space at the retreat, full payment or a deposit must be made upon registration.

Please book mindfully, as we are unable to offer refunds for cancellations or changes of mind.

If unforeseen circumstances prevent your attendance, we will make every effort to fill your spot.

Should your place be successfully filled at the same rate, we will issue a refund, minus a $200 administrative fee.

In the rare case that your place cannot be filled, your payment or deposit will be non-refundable.

Thank you for your understanding, as small businesses rely on full bookings to continue offering these experiences.

RETREAT fees and part thereof are non-refundable.

4. We ask all attendees - No strong perfumes are to be worn at the retreat, due to allergies and medical conditions.

5. I am not suffering from any medical conditions, allergies, or food intolerances that I have not made aware Julie-Anne of.

6. Any information or guidance given during The Path to Peace Bali Retreat is not intended to replace any professional medical advice.

7. I am attending the retreat of my own free will and Julie-Anne does not take any responsibility for any injuries, physically or mentally.

8. I am in good health and am fit enough to go on walks, waterfall excursion, there is some stairs and other cultural activities.

9. I am aware that I am responsible for my own health, probiotics, vitamins, medications and mosquittto protection.

10. By signing this form you agree and will comply with the code of conduct and guidelines of the Into the Heart Bali Retreat, this are put into place for the safety of all.

Payment Details - Below

We are so glad you have said YES to YOU and we are looking forward to holding space for you at Into the Heart Bali Retreat. So Excited.

With Love and Gratitude

Julie-Anne.

I am aware that

You agree to be photographed at times at the retreat, with images potentially used for future marketing and promotional purposes.

Signature

Booking Options:

You have two easy options to choose from:

Option 1: Paying the full amount - fill out the registration form and pay the depoist as the transaction fees are way too high for the full amount. We will then send you a welcome email with banking details for the balance, then you are all done, your place is secured!

Option 2: Payment Plan Or Part Payment - Please Pay the $699 deposit on registering to secure your place.

Balance must be paid in full by 15th of September 2027, As per payment plans agreement. (Website)

We are only taking 6 women on this magical Bali Retreat. This intimate setting ensures a deeply personal and enriching experience for each participant.

We have 6 Private Deluxe Garden or Pool Rooms available

Payment and Bookings

Private Room - Deposit

$699.00 AUD Quantity

Total

Credit Card

The Path to Peace-Bali Women's Retreat Registration

Payment and Bookings

Credit Card