Survive and Thrive Retreat

Name (as in Passport)

First NameMiddle NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Email

example@example.com

Birthday

Date

Country of Residence

Street Address

Street Address Line 2

Country

Nationality

What communication platform do you use?

Other

Age

How did you learn of our retreat?

Translations and Special Requirements

Other

Name

First NameLast Name

Relationship to you

Phone Number

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

Email

example@example.com

Mode of Contact

*Whatsapp is the best mode of contact for us in case of emergency

I full name*, confirm that I am voluntarily participating in this Retreat.

I acknowledge and affirm that the teachings imparted at this Retreat are the intellectual property of Master Del Pe and MDP BElife^TM and cannot be divulged or taught by me in any manner, unless I have been certified as a trainer to teach them.

I give permission for my photos, videos and testimonial to be used and release Master Del Pe, WIID, BEwell ScienceTM from any liability, legal or otherwise, for the use of my testimonial or story in books, websites, flyers, articles, media requirements and other legal uses without contract or fees.

I have read this waiver and fully understand its terms and implications. I acknowledge that I am signing this document freely and voluntarily.

Signature* First Name* Last Name* Date*

WAIVER

Signature

Payment

Your participation will only be confirmed once the full payment has been made. Please submit your retreat payment at www.bihcglobal.com/payments.

Please send your proof of payment to register@masterdelpe.com to confirm your slot.

Thank you and we wish you an empowering retreat!

Survive and Thrive Retreat

Emergency Contact Information