Chiang Mai Retreat Application

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To create a transformative experience for all attendees of this retreat, we carefully review everyone's intention and readiness to dive deep and co-create this experience.

Name *

First and last name

Email *

Phone number (with country code) *

Please share with us your birth year. In case we need extra documents for underage attendees. *

Have you attended any retreats in the past? *

Yes

If you have, please share how those retreats affected you.

What is your intention coming to this retreat? *

What are some blocks or baggage you intend to release by coming to this retreat? *

Do you have any food allergies? Please list them. *

Do you have a special diet? Vegetarian/plant-based/halal? Please state what you cannot eat. *

Do you have any existing health condition that we need to be aware of? Sleep-walking/heart conditions/etc. *

Do you feel that you are currently in a crisis and need a lot of emotional support? *

Yes

Do you need any special accommodations? Wheelchairs/ramps/hearing aids/childcare/visual help? *

A big part of the retreat experience is being open to receiving new ideas and building new connections. Please rate your openness and readiness to receive new perspectives. *

I don't think I can learn anything new

I am an empty cup excited to learn and explore

A healing part of any retreat is the time to connect with ourselves and with each other. Please rate your openness and readiness to connect with the other attendees. We will build in a lot of time alone and time to interact with each other. You are not expected to do anything that you do not want to. *

I mostly or only want time alone

I am open to meet new people

As an attendee for this retreat, I am empowered and accountable for all my emotions and feelings that arise in this container. I will be present with my feelings and ask for support from the staff. *

Yes

For my own health and medical needs, I will purchase my own travel insurance and have an emergency contact and medical insurance card with me. *

Yes

Are you ready to pay the deposit and confirm your spot after we review and approve your application? *

Yes

Would you like a free inquiry call to speak with one of our staff members so we can answer more questions? *

Yes

Please give us a few times and days of the week that you are available for the call. Please include your local time zone or city. (e.g. Mon after 5pm EST/Boston time, Sat morning before 11am Taipei) *

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