Balinese Healer Training 2025

Balinese Healer Training

September 26 - October 5, 2025
Registration Form

Please fill out the following form. Once we have received your deposit, you will receive a confirmation email, letting you know that you are registered for the retreat. Space is limited, so reserve now!
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
example@example.com
Birth Date:*
xx/xx/xxxx
Emergency Contact Information*
Name, Relationship & Phone Number
Do you have prior Yoga experience?*
Do you have any prior Reiki or Energy Healing training?*
What are your general goals for this retreat?*

Learn About Balinese HealingPersonal HealingPhysical Well BeingPeace of MindDeeper Understanding of ChakrasLearning to Tune In to EnergyHealing OthersStudy with Pak Made GuruOther
Please share any other intentions or goals for this Training. *
Food Sensitivities or Medical Conditions you would like us to know about:*
Please List
Room/Roommate Request:*
Name of request
Payment

To reserve your space either payment in full or a $500 deposit with 2 additional scheduled payments is required. If you are making scheduled payments, the list of dates are as follows: 1/2 of your remaining balance is due 4/1/25 and the remaining balance is due 6/1/25. We accept Venmo, Zelle, personal check and all major credit cards. Please Note: a 4% processing fee will be added to all credit card payments.
Payment Plans Available

If you would like to set up a payment plan, please contact us. We are happy to work with you. Payment is due in full by June 1, 2025.
Liability Waiver, Terms, and Conditions

Payment and Cancellation Policy: To reserve your space a $500 non-refundable deposit is required. Cancellations after registration will be refunded at 75%, minus the non-refundable deposit payment of $500. Cancellations within 90 days prior to departure will be refunded at 50%, minus the non-refundable deposit payment. Cancellations within 60 days of departure are non-refundable. All cancellations must be in writing and sent via email. There is no refund for any unused portions of the tour, including but not limited to, missed meals, hotel nights and sightseeing. Tour rates do not include airfare to Bali. You will need a valid passport to travel to Indonesia.
Insurance and Liability:

Taking any trip can incur delays and changes. That is why we require travel insurance to protect both your investment and yourself. We recommend Allianz Travel Insurance: https://www.allianztravelinsurance.com Once you have your travel insurance, please email that confirmation to roxanna.smith@gmail.com If you purchase travel with a travel credit card your trip may be automatically covered.
Waiver:

I understand this contract and agree to release Christy Linson & Roxanna Kopp Smith from any responsibility of loss, damage, or injury that may occur on this trip. I agree to assume all risks associated with this trip including, but not limited to, costs resulting from travel delays, damage to myself and/or my property, or any incidents occurring out of the control of Christy Linson & Roxanna Kopp Smith, as well as any activities not associated with Christy Linson & Roxanna Kopp Smith. I agree that I must show proof of travel insurance in order to participate in this tour.
By checking this box, I state my understanding and agreement with the waiver, terms, and conditions of this contract*

I agree
Photo Release:

I grant Christy Linson (CL) and Roxanna Kopp Smith (RKS) the right to take photographs of me and my property in connection with the above subject. I agree that CL & RKS may use any such photographs of me with or without my name and for any lawful purpose, including publicity, illustration, advertising and web content.
By checking this box, I state my understanding and agreement with the photo release, terms and conditions of this contract*

I agree
Should be Empty:

Balinese Healer Training

Registration Form

Payment

Payment Plans Available

Liability Waiver, Terms, and Conditions

Insurance and Liability:

Waiver:

Photo Release: