Unplugged Retreat Booking Form
Please fill out the following booking form and submit and we will respond as soon as possible with confirmation of your booking.  One form per person.

Please note, full payment is required upon booking, payment details will follow once your spot has been confirmed.
Full Name *
Email Address *
Contact Number *
Date of Birth *
Emergency Contact Details *
Room Preference (subject to availability) *
If shared, are you coming with someone else?
Clear selection
If answered yes to previous question, please state who you would like to be in a room with
Dietary Requirement *
Injuries & Illnesses *
Submit
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