Registration Form

Welcome to the Transference Healing® Fundamental Training Retreat at Angkor Grace Wellness Resort, Siem Reap, Cambodia from 20th-27th November 2025.

Some of your training kit will be posted to you after the retreat, please fill in your forwarding address where you would like the essences to be delivered to.

Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

E-mail

example@example.com

How did you hear about us?

Where will you be coming from?

What Is Your Accommodation Preference?*

One Bedroom Apartment2 Bedroom Apartment - Shared accommodation - Queen Room2 Bedroom Apartment - Shared accomodation - Double Room

(Optional Extra) Are you looking at bringing someone with you (friend or family member) who will not be attending the Training days?

Yes - a package price will be advised for youNoOther

(Optional Extra) Any Extra Nights Stay?*

Yes, please - One bedroom Apartment - cost is $190.80USD/$302.96AUD per nightYes, please - 2 bedroom Apartment - Queen Room - $132.50USD/$210.48AUD per nightYes, please - 2 bedroom Apartment - Double Room - $106USD/$168.38AUD per nightNo thanks

If yes to extra nights stay, how many nights & please advise if it will be before &/or after the retreat.

(Optional Extra) Are you interested for a car transfer to be arranged?*

Yes, from Airport to Resort-one way - $60.00USD/$95.31AUD per car (2 people max) $70.00USD/$111.20AUD per car (5 people max)Yes, from Resort to Airport-one way- $60.00USD/$95.31AUD per car (2 people max) $70.00USD/$111.20AUD per car (5 people max)Yes, pick up and drop off- $120.00USD/$190.62AUD per car (2 people max) $140.00USD/$222.40AUD per car (5 people max)No thanks, will arrange own transport

Please advise of any dietary requirements for the lunch, dinner, morning & afternoon teas during the 3 training days.*

Is there any pre-existing medical concerns that we should be aware of. On the tour days there will be some walking and going up stairs required and in the resort also has small amount of stairs, will this be a concern for you?

Is there anything else you would like to share?

Would you like to pay in Full or in 5 Installments (first installment is 30%deposit). Please note if you have added any optional extras, the package cost will be different then the advised amount.*

In Full5 Installments - first installment being 30% deposit

Select your accomodation and payment type*

One Bedroom Apartment, Pay in FULL - $7,273AUDOne Bedroom Apartment, Pay in 5 Installments - $2,181.90AUD (30% Dep) & 4 payments of $1,272.76AUD (schedule to be advised)2 Bedroom Apartment - Queen Room - Pay in FULL - $6,662AUD2 Bedroom Apartment - Queen Room - Pay in 5 Installments - $1,998.60AUD (30% Dep) & 4 payments of $1,165.85AUD (schedule to be advised)2 Bedroom Apartment - Double Room - Pay in FULL - $6,296AUD2 Bedroom Apartment - Double Room - Pay in 5 Installments - $1,888.80 (30% Dep) & 4 payments of $$1,101.80AUD (schedule to be advised)

Do you give permission for any photographs or videos taken of you during the retreat to be used for marketing and promotional purposes on social media, internet and printed material?

YesNo

What inspired you to register for the Retreat?*

How long have you been on your spiritual Journey? Or is this all new to you?*

What are you hoping to achieve as a result of attending the Transference Healing® Fundamental Training?*

Terms & Conditions for Cancellation
Fundamental Training Component
1. Any cancellation made there is a non-refundable amount of $1,430.00 being for the Fundamental Training Kit that is supplied. These are ordered immediately and the essences programmed for you so they can not be given to someone else.

Accommodation Component
1. Any cancellation made prior to the 30 June 2025, there is a non-refundable amount of 25%, for the accomodation component.
2. Any cancellation made after the 30 June and before the 30 October 2025 there is a non-refundable amount of 50% for the accomodation component.

Complete Package
1. Any cancellation made after the 30 October 2025 - there is no refund, you can transfer the package to when the next Retreat is scheduled the following year.

Do you agree to the terms and conditions?*

What's Next:

Once you hit the SUBMIT button, and the form is recieved you will be contacted shortly via email to finalise any details and process your deposit.

Signature*

Please sign your name by using the mouse on a computer or laptop. If your using your mobile phone, you can sign using your finger.

Date

Registration Form

Contact Details:

Accommodation Preferences:

Payment Options