Registration Form Wholesome Holistic Getaway Friday 26th-Sunday 28th April

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Registration Form: Please fill out the form for every person attending the retreat

michelle kliczkowski *

03.02.1986 *

YYYY

So we can understand which room to pur you in:

Female

Male

Prefer not to say

mother and 4yr old son

Other:

Clear selection

mi.klicz@gmx.de *

0221705162 *

Would you like to join the Bhakti Lounge mailing list to find out about upcoming events? *

Special dietary requirements (All our meals are plant based.)

Gluten low and dairy low, I can eat oats

Other:

Are you looking for a ride from Wellington? *

No, the directions to get to the retreat in the email Karuna sends the week of the retreat.

Have you been to our retreats before? *

No, this is the first time

Have you been to any events at Bhakti Lounge before? *

Yes

At this retreat, we will have a *Skill Share Session:* an optional open-floor session to share your talents or skills in a safe, mellow space. If you have a talent you would like to share please let us know here and Karuna will be in touch to discuss more!

Please kindly acknowledge your understanding and agreement with the following conditions: the accommodations at our retreat are shared and single-sex, with the possibility of sharing a room with up to four individuals. Additionally, we maintain a retreat center that prohibits any meat, fish, eggs, alcohol, drugs, and caffeine. Moreover, smoking is strictly prohibited on the retreat property, and we kindly request that it be conducted off-site.
*

Do you have any questions you would like to know?

Please make a payment by hitting the button below this form, we can only guarantee your spot once payment is recieved. Thank you we look forward to having you at our retreat!

Thank you! We look forward to having you at the retreat!

I will make my payment for the retreat now

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