Clone of 2027 OJAI Brainspotting (FEB 25

NAME

First NameLast Name

Email

example@example.com

Mobile #

Please enter a valid phone number.Format: (000) 000-0000.

Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

My main interest in attending this healing immersion: (check all that applies)

Food Preference --

If other, please list preference below

Allergies: (type none if you have no allergies

2-person Cabin - Topanga Breakthrough

Available - Standard rate is $1350 starting OCT. 1st.

$1,200

Shared Guest House - Topanga Breakthrough

Available - Same gender roommate(s) will be assigned.

$1,500

Small Private Cabin - Topanga Breakthrough

Available - Shared bathrooms.

$1,550

King Suite w/ private bath - Topanga Breakthrough

Two available for single occupancy. Email Joy if you need double occupancy rate.

$1,995

COMMUTER - Topanga Breakthrough

Spots available. Retreat and all meals. No lodging.

$995

DEPOSIT - Topanga Breakthrough

Pay balance by Oct. 5. We will email you a payment link.

$500

Total

PREFERRED ROOMMATE: Enter name(s) below. Otherwise you will be paired with other same gender participants.

Food Preference/Allergy Information