Deepening Connection with Infinite Self Retreat
For those committing to our upcoming offering:
November 9 - 12th, 2023 

Nov. 9th -- 5 p.m. to 8 p.m.
Nov. 10 & 11th -- 10 a.m. to 6 p.m.
Nov. 12th -- 10 a.m. to 3 p.m. (possibly ending earlier; please ensure you have a solid breakfast this day as there will not be a lunch break)
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Email *
Which retreat would you like to attend?  *
Name (First and last name) *
Phone Number *
City & State *
Your current age *
City, Country of Birth *
Current Occupation (s)
Your Website (if applicable)
What is your draw to participating in this retreat offering?  Why now?   *
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 early bird payment of $875 (per retreat) to reserve your seat?  Please ensure that you make your payment immediately after filling out this form in order to complete your registration. 

Early bird offering is valid until March 24th for the April retreat, and until Oct. 1st for the Nov. retreat.  Thereafter, the rate will increase to $1050.

No refunds are offered. 
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