Rebirth Retreat Bali Application form

Thank you so much for your interest in the Rebirth Retreat June 2020

Here are a few questions to help see if this is a good fit for you. Once your application has been considered I will contact you and offer you ways to book in and reserve your space. Thanks again for your interest and taking the time to fill this out;)

Full Name

Email Address

Which country will you be travelling from?

Please share a little about yourself and why you are drawn to this training

Are you happy to respect the periods of silence during the retreat and abstain from alcohol or other stimulants for the duration of the training?

Have you experienced sexual trauma? What kind of support/therapy have you had for this?

Are you willing to be self-responsible for your own healing process and speak your needs if any arise?

Are you on any medications and do you have any history of psychosis?

Are there any dietary or health requirements we need to know about?

Thank you so much for your interest in the Rebirth Retreat June 2020

Two Step