New Paradigm Project: Aligned Expansion Experience Retreat

Hello! Congratulations on making this decision to invest in yourself and joining this experience. This isn't just a retreat or a program - this is a movement and I am so excited to have you on board and to share this experience with you!!

Please complete the information below and let me know if you have any questions!

Lori

Guest Information

Name

First NameLast Name

Email

example@example.com

Cell Phone Number

Country CodeArea CodePhone Number

WhatsApp Number (we will use this while in Bali)

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Birthdate (to pull your charts)

Please note that no one under the age of 18 years of age is permitted.

Location of Your Birth (used to pull your charts)

Time of Birth (used to pull your charts, you can send this after registration if you do not have it available when completing this form)

Tell me a little about yourself, your intentions and why you want to attend this retreat.

Emergency Information

Emergency Contact's Name

First NameLast Name

Phone Number

Country CodeArea CodePhone Number

Alt. Phone Number

Country CodeArea CodePhone Number

Emergency Contact Email

Have you practiced Yoga before (This is not a "yoga retreat" and experience is not required, this just gives an idea of where you are at with your movement practices)?

If You answered Yes, What is Your Experience Level?

Do you have any health limitations or physical injuries that we should be aware of? Please share more below regarding any limitations or any major health issues (ex high/low blood pressure, arthritis, asthma, diabetes, seizures, osteoporosis, allergic to bee stings, etc.) or any health concerns that may limit your ability to fully participate in organized activities.

Do you have any special dietary requirements? (eg: gluten-free (please specify if you are celiac), allergies, vegan etc…) *We may be unable to accept attendees with severe food allergies as we cannot guarantee an environment free of cross contamination, if this applies, please contact Lori directly

Please add anything else you'd like to share or that you think we need to know below.

Have you made your first deposit yet?

Were you referred by someone? If so, please list their name and/or discount codes below:

I am aware that during my participation in this experience, that certain risks and dangers may arise, including, but not limited to, the hazards of traveling to the retreat location, forces of nature, an accident or the onset of illness. Also I am aware and clearly understand that Lori Konkler, Xennial Traveler LLC or any of our associated vendors or venues do not have liability regarding provision of medical care, the speed of evacuation or the adequacy of any care that may be rendered.

I understand that Lori Konkler and Xennial Traveler LLC will use their best efforts to ensure that all adequate measures are taken to avoid such occurrences. Certain risks and dangers may arise on your retreat, including, but not limited to, the hazards of traveling to the retreat location, forces of nature, an accident or the onset of illness.

Lori Konkler and Xennial Traveler LLC will not be held liable for events arising out of or relating to any injury,loss or damage to person and property that may be sustained as a result of participation in the Bali Retreat. Lori Konkler and the company, Xennial Traveler LLC Are released of all claims, actions, lawsuits, damages arising out of your participation on the Retreat.

Each retreat participant is required to have their own travel insurance to cover any unforeseen issues or cancellations. Lori Konkler and Xennial Traveler LLC recommend to include a "cancel for any reason" clause to your insurance.

Some of the activities, coaching and support that happen throughout this experience both virtually and in person will include additional wellness activities that may carry risks for certain groups of people.

This includes, but is not limited to - mediation, yoga, human design/astrological or other readings and interpretations, EFT, energy healing, plant medicines and other mindset and energetic work.

This work can be deeply healing and very supportive to your ongoing success journey however, it is designed for those that are in a position to handle the feelings, thoughts and other things that may arise out of doing this work or that have a supportive, counselor/therapist or other professional to help sort through whatever may arise in a private capacity.

By participating, you agree that you are of sound mind and body to participate in this work and that if anything becomes uncomfortable or feels like the wrong direction for you, that you will immediately bring this to the attention of Lori Konkler and/or your practitioner.

This is NOT a substitution for therapy or medical care. If you have had serious trauma that is unhealed, untreated/uncontrolled psychiatric or mental health conditions, this is not the ideal space for you at this time.

The participant takes full responsibility in participating in this experience and attending this Bali Retreat.

By signing the Retreat Contract I am voluntarily participating in these activities with the knowledge of the dangers involved and hereby agree to accept any risks.

I am also acknowledging that I understand that there are no refunds for any reason and that it is my responsibility to secure travel insurance to cover any issues or cancelations that may occur.

Your place is secure only upon payment of deposit. Proof of comprehensive travel insurance is requested after registration, if proof is not received prior to the retreat, registration may be canceled and all payments forfeited.

If you are opting for one of our payment plans, all payments must be made according to the agreed upon unless otherwise agreed upon in writing:

Your first payment is due immediately and remaining payments will automatically be withdrawn from your account monthly until all payments are received.

Your space is confirmed by your completed registration, payment(s). Proof of travel insurance may be requested, if not received prior to the retreat, your registration may be canceled and all payments forfeited.

As lawful consideration for the agreement with Lori Konkler and The Xennial Traveler to participate in this retreat, I hereby agree that I will not make any claim against Lori Konkler or the Xennial Traveler LLC. By signing this form and agreeing to the Terms and Conditions above and linked below will serve as my release of Liability and Assumption of Risk agreement.
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Signature

Date Signed

Date

Aligned Expansion Retreat - Bali Indonesia, December 2026

Terms and Conditions and Assumption of Risk and Liability