Radiant of Light Retreat in Bali

Registration for Radiant of Light Retreat - Bali

This is for individuals who will participate n the Radiant of Light Retreat
Please register your legal name as it will appear on your passport. 1 Person Per registration.
Name*

First NameMiddle Name (if applicable)Last Name
Date of Birth*
E-mail*
example@example.com
Phone Number*

Country CodeArea CodePhone Number
WhatsApp Phone Number*
If you do not use the application WhatsApp - Please download it. Please provide a WhatsApp Phone Number (your regular mobile number in the application) so that if you are traveling alone we can call and text you.
Please list your citizenship*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Room Request

SingleDouble
If you have requested a double - please list your partner or roomate’s name.
We note that are not responsible for getting a roommate for you if you request a double.
Please check the Payment Option - Whether paying in full or using a payment plan $1000 will count as your deposit for the trip. Note - 1 person per registration*

Making Full Payment NowMaking A DepositPayment plan
Do we need to arrange transportation to Bali Airport ? Note this is at the participants expense. Check in at the retreat center is 2pm.

YesNo
Will Transportation be needed to get to the Airport - Checkout is 10am at the retreat center.

YesNo
Travel Health Information
Use this area to list health concerns we should be aware of. *
We MUST be aware of any serious health conditions please.
Emergency contact names and number
The person listed will be contacted for any health emergencies - and health decisions - Please make sure it is the correct person.
Please read the terms and conditions carefully.

It has all the policies, requirements and expectations as a participant for this retreat. It lists our:
- Requirements
- Release Statements
- Cancellation Policies
- Refund Policy
Please take the time to read this document.
I acknowledge that I have read this registration form completely, I understand the requirements, and the information I provided is accurate. I understand and acknowledge all the requirements and policies as listed.
By checking this box - like a signature - you agree to the terms and conditions as well as the refund and cancellation policy.*

Yes
This registration is for payment in USD. Please select the correct option below.

If this does not work for you, contact us. We work with Stripe, Zelle, Paypal, Wise, Revolut and Bank Transfers. Contact jromanskifilms@gmail.com by email or WhatsApp - +1-607-542-6388 and we will work with what is best for you.
My Products*
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Radiant of Light Retreat Bali - Single Room Request
Please 1 registration - 1 attendee

$2,639.00 Quantity



Deposit - Single Occupancy
Please accept this as a deposit on behalf of attending the Radiant of Light Retreat in Bali. I will receive 2 consecutive payment links over the next 2 months same date to complete my payment. Payment completion must be by October 1st, 2026.

$1,000.00 Quantity



Radiant of Light Retreat Bali - Double Room
Please 1 registration - 1 attendee

$2,369.00 Quantity



Deposit - Double Occupancy
Please accept this as a deposit on behalf of attending the Radiant of Light Retreat in Bali. I will receive 2 consecutive payment links over the next 2 months same date to complete my payment. Payment completion must be by October 1st, 2026.

$1,000.00 Quantity



Total

$0.00
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Registration for Radiant of Light Retreat - Bali

Please register your legal name as it will appear on your passport. 1 Person Per registration.

Travel Health Information

I acknowledge that I have read this registration form completely, I understand the requirements, and the information I provided is accurate. I understand and acknowledge all the requirements and policies as listed.