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*

Emergency Contact *

First NameLast Name

Relationship to you

Type

Phone Number*

Please enter a valid phone number.

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 Into the Heart 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 do not take any responsibility for any injuries, physically or mentally.

8. I am in good health and am fit enough to do yin yoga, go on a nature walk, waterfall excursion 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*

International Airfares, visas etc are not includedI must have travel InsuranceExtra food, snacks and soft drinks are not includedSpa treatments are not includedInto the Heart Retreat is an alcohol-free retreatI will need my own spending money

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

YesNo

Signature*

Booking Options:

You have two easy options to choose from:

Option 1: Pay the full amount now by clicking on the book now tab, fill out the registration form and you are all done, your place is secured!

Option 2: Payment Plan - Pay a $699 deposit on registering to secure your place.

Twin Share - 4 payments of $750.00

Must be paid in full by 30th of July 2026

Private Room- 4 payments of $900.00

Must be paid in full by 30th of July 2025

We are only taking 8 women on this magical Soul-Full Heart Bali Retreat. This intimate setting ensures a deeply personal and enriching experience for each participant.

Payment and Bookings

Twin Share Villa - Paid in Full Product Image

Twin Share Villa - Paid in Full Twin Share - Paid in Full

$3,699.00AUD Quantity

Twin Share Villa - Deposit

$699.00AUD Quantity

Private Villa - Paid in Full

$4,299.00AUD Quantity

Private Villa - Deposit

$699.00AUD Quantity

Total

$0.00AUD

Credit Card