Retreat with Selena in Bali
Application
Name
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First Name
Last Name
Email
*
example@example.com
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Why do you wish to attend this retreat?
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Which areas of your life would benefit most from participating?
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What are you ready to receive in your life experience?
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Do you have a daily spiritual and/or meditation practice? If yes, what does it entail?
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Do you exercise regularly? If yes, how often and what types? This retreat will offer daily movement activities.
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All rooms are double occupancy. You can bring a friend or loved one, or you will be assigned a roommate. Please select your room choice. **All rates are per person**
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Panorama Suite: $3,300
Panorama Luxury Suite: $3,600
Panorama Penthouse Suite: $4,100
I am bringing a friend or loved one to share my room.
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Yes
No
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Additional comments or questions
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