Retreat Registration Form
Yoga & Healing Retreat | 11 - 14 Dec 2025 - Ubud, Bali
Participant Information
Name
*
First Name
Last Name
Country of Residence
*
Email
*
example@example.com
Mobile Phone Number
*
-
Country Code
-
Phone Number
Instagram Handle
Room type
Shared twin room (shared with another participant)
Private Room
Large Room for couple / friends (double bed only)
How would you like to pay? (A payment link will be sent to your email.)
Full payment (bank transfer / credit card )
Deposit only – IDR 2 million or USD 125
I need more info before paying
What's next
After you submit, we’ll send you the payment link and your full registration form to complete your booking.
Submit Form
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