Ubud, Bali March 21, 22 & 23

Name *

First

Last

Nationality on Passport

Telephone (mobile, whats app) for texting

Email *

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

How did you learn of the retreat?

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

When did you last arrive in Bali (date, please)?

In what countries were you prior to coming to Bali?

Check here that you commit to attend all 3 days and 6 sessions.

Check that you are in good health and not coughing or feverish.