Level 2 Healing Retreat
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
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.
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Which Level 2 Healing Retreat would you like to attend?
October 7-13, 2026 — Austin, TX (all full)
February 7-13, 2027 — Tuscany, Italy
Austin Level 2 Retreat (All Full) | Please select a Payment Plan option:
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Option 1: Pay in Full (Receive $200-off bonus: $6,800 USD)
Option 2: Payment Plan (Total: $7,000 USD): $500 deposit + $3,000 USD by July 1st, 2026 + $3,500 USD by August 1st, 2026
Italy Level 2 Retreat | Please select a Payment Plan option:
Option 1: Pay in Full (Receive $200-off bonus: $7,600 USD)
Option 2: Payment Plan (Total: $7,800 USD): $500 deposit + $3,650 USD by October 1st, 2026 + $3,650 USD by December 1st, 2026
Choose Your Payment Option:
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Austin Level 2 Retreat | Pay in Full
$6,800.00
$
6,800.00
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Austin Level 2 Retreat | $500.00 Deposit
$500.00
$
500.00
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Italy Level 2 Retreat | Pay in Full
$7,600.00
$
7,600.00
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Italy Level 2 Retreat | $500.00 Deposit
$500.00
$
500.00
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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
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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.
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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 retreat in-person 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.
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Yes, I understand and agree.
No, I cannot make this agreement at this time.
Signature
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Submit
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