APPLICATION FORM: Liberate Your Voice       
10-DAY RETREAT & ARTISTIC PRODUCTION 
November 15-25, 2022
Mazunte, Mexico
อีเมล *
E-mail *
First Name *
Last Name *
Pronoun
Age
Nationality
Contact Phone Number (Whatsapp / Telegram / Phone) *
Instagram / Facebook / Website
What is your intention in joining this retreat? 
What do you hope to gain from this experience? 
 *
How did you hear about us? 
Did someone specific refer you?
 *
Is there anything you would like us to know regarding your physical or mental health for your stay with us? Don't hesitate to provide as much details as you would like! 
 *
Are you applying for a LOCAL PRICE ?

This rate is for people, who are based or living in Central or South America. 
( Price doesn’t include accommodation or food. )

* we can help you to find good accommodation 
* if you want to purchase the meals at our retreat centre, let us know and we will communicate with you the price per meal 
 *
For your accommodation, are you? 
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If you are coming with a good friend, would it be ok with you both, to share a very big king size bed ? 
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If you are coming as a couple, do you want to share a queen or king size bed and have your own private room?
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Investment  *

A non-refundable deposit of 700 USD is required to hold your reservation. The remaining total amount can be spread over 2 subsequent payments or preferably paid in 1 payment. The full balance must be paid by October 31st, 2022.


Please, indicate your preference.

 *
Do you have any food allergies or dietary restrictions? If so please specify bellow:  *
We will do our best to design a perfect menu for you, please let us know your preferences. *
Is there anything else you'd like to share with us?
Thank you so much for taking the time to fill this out! We will be in touch with you soon! A copy of your responses will be emailed to the address you provided.

With love, Eva and Emma 
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