Application Form

2-4 August 2024, Middleton South Australia

Thank you for your interest in our upcoming winter Retreat! Please fill in this application form to receive further information on the Retreat.

First Name *

Last Name *

Email *

Phone *

State/Province *

Date of birth *

Gender (Female only retreat) *

Female

Male

Do not wish to disclose

How did you hear about our Retreats? *

Accommodation Preference:

Private Room with Single Bed + Spa

Private Room with Queen Bed + Spa

Shared Room with Single Bed

Shared Room with Queen Bed

Shared Room with Single Bed + Spa

Shared Room with Queen Bed + Spa

Private Cabin with Queen Bed

Are you applying for a retreat Scholarship?

Yes

No

If Yes, please tell us why you are apply for the scholarship option ($997). We will review your application for the scholarship based on the information you provide here.

By submitting this retreat application form you agree to be contacted by phone or email with further information on pricing and accommodation options.

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