Registration / Form

Soul Sister Bali Retreat 2019
Registration form

Deposit must be paid be paid through this form or via check within 72 hours of submission.

* Indicates required field

Name *

First

Last

Date of Birth / Day *

Month *

Year *

Email *

Confirm Email *

Phone Number *

How do you wish to make payment *

Online Direct to Account By cheque within 72 hours (£550)

After submitting your £550 deposit, how do you wish to pay the remaining balance of your trip? *

In one payment In two payments

Occupancy *

If you selected double occupancy, do you have a preferred roommate ? *

Yes No

If yes, please indicate your preferred roommate's name here: *

Are you taking any medicines *

Yes No

Please read Carefully our Terms and Conditions

Submit