Level 2 Healing Retreat
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
To reserve your place, please confirm your agreement to submit the full payment prior to the Retreat by typing “I AGREE” in the box below.
*
Which Level 2 Healing Retreat would you like to attend?
Italy Level 2 Healing Retreat (Waitlist Available)
Austin Level 2 Healing Retreat
Italy Level 2 Healing Retreat | Please select a Payment Plan option:
Option 1: Pay in Full (Receive $200-off bonus: $8,000 USD)
Option 2: Payment Plan (Total: $8,200 USD): $500 deposit + $3,850 USD by October 1st, 2026 + $3,850 USD by December 1st, 2026
Austin Level 2 Healing Retreat | Please select a Payment Plan option:
Option 1: Pay in Full (Receive $200-off bonus: $8,000 USD)
Option 2: Payment Plan (Total: $8,200 USD): $500 deposit + $3,850 USD by December 1st, 2026 + $3,850 USD by February 1st, 2027
Choose Your Payment Option:
*
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Pay in Full | Italy Level 2 Healing Retreat
$8,000.00
$
8,000.00
Quantity
1
2
3
4
5
6
7
8
9
10
$500.00 Deposit | Italy Level 2 Healing Retreat
$500.00
$
500.00
Quantity
1
2
3
4
5
6
7
8
9
10
Pay in Full | Austin Level 2 Healing Retreat
$8,000.00
$
8,000.00
Quantity
1
2
3
4
5
6
7
8
9
10
$500.00 Deposit | Austin Level 2 Healing Retreat
$500.00
$
500.00
Quantity
1
2
3
4
5
6
7
8
9
10
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Please confirm your understanding that upon submission of this contract, your initial payment (as indicated above) is due upon receipt and that all payments are non-refundable.
*
Yes, I understand.
No, I can't make the initial payment right now. *If this is the case, your application will not process until after you've had a conversation with our financial department.
Please confirm your understanding that coming to this in-person retreat is your responsibility and if you are unable to attend the retreat for any reason, all payments are still due in-full and are non-refundable.
*
Yes, I understand and agree.
No, I cannot make this agreement at this time.
Signature
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Submit
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