Bali Retreat Rego | World Dharma

Name *

First

Last

Address

City/Town

State/Provence/Territory

Country

Telephone (mobile, whats app) for texting

Email *

Your Facebook or Instagram account for MSG, as emails often go to spam

Nationality on Passport

Occupation (if applicable)

How did you learn of the retreat?

In a sentence or two, please explain why you want to participate in the retreat.

Are you intending to bring friends? If so, please list their names and emails.

If the retreat fills preference will be given to those who attend the most sessions.

or, check the the boxes of sessions you wish to attend: