Deepening Connection with Infinite Self Retreat
For those committing to our upcoming offering:
October 7 - 10th, 2021
Oct. 7 -- 4 p.m. to 8 p.m.
Oct. 8 - 9 -- 10 a.m. to 6 p.m.
Oct. 10th -- 10 a.m. to 4 p.m.
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Email *
Name (First and last name) *
Phone Number *
City & State *
Your current age *
City, Country of Birth *
Current Occupation (s)
Your Website (if applicable)
Will you be attending with an intimate partner, spouse, beloved?  Or family member? *
What is your personal experience with Conscious Breathwork?  What benefits have you experienced? *
What is your personal experience with Cacao ceremony? What benefits have you experienced with this? *
What are the main healing modalities and inner work practices you have done (received and/or given) so far? *
What is your relationship with the greater energies, God, Source, Spirit, however you choose to call it? *
What are your hopes, desires, intentions in joining this retreat? *
What is alive and moving in you, that you desire to transform, shift, move through at this moment in your life? *
Do you have any PTSD, trauma experiences?   *
Do you agree to abide by the agreements of: honor self, honor other, you take responsibility for your experience and feelings, agree to hold all in the highest integrity of confidentiality -- that which is shared in circle, stays in circle?   *
Do you agree to stay in connection from the opening of the our first session to our last session together?  Ie you don't disappear on us, you stay from opening to close, you communicate with us, even if/when things may get challenging within for you or with another. *
Do any of the following situations apply to you: *
Required
How would you rate your overall physical health? *
How would you rate your overall mental health? *
Are you willing to let go of the version of who and how you have been to grow into the version of you that awaits? *
Required
Is there anything else you would like to share? *
I or my representative(s) agree to fully release and hold harmless, Gurpreet K. Gill and Atman Healing, from and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with, directly or indirectly, from their services and session(s).”I have read the above informed consent, understand, and agree to it. *
How will you complete the payment of $700  to reserve your seat?  (please note that no refunds are offered) *
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