Fresh Start Cleansing Retreat

Please use this form to check availability. Although the availability is updated daily it might be that a retreat is no longer available. We recommend you to book your flights only after we confirm your booking

Please select your options:

Retreat in Ubud schedule for 2011 on:

February 18 - 25, 2012
November 17 - 24, 2012

* Although the availability is updated daily it might be that a retreat is no longer available. Please use this form to check availability.

Occupancy

Single Occupancy Twin Share (1 bed) Twin Share (2 beds)

If you are sharing a room, what is the name of your room mate?


Please note: Each participant must fill this registration form separately.

Personal Information

• First Name
:
*


• Family Name
:


• Home Address
:


• Country
:
*


• Home Telephone Number
:
*


• Office Telephone Number
:


• Mobile Phone Number
:


• E-mail address
:
*


• Re-enter your email
   address
:
*


• Arrival Flight Date
:
   


• Arrival Flight Details to Bali
:
Airline :      Flight #


• ETA (estimated time
   arrival)
:


• Departure Flight Date
:
   


• Departure Flight details
   from Bali
:
Airline :      Flight #


• ETD (estimated time
   departure)
:


• Will you stay with us prior
   to the retreat?
:
Yes No


• If yes, date of arrival at
   ONEWORLD retreats -
   Kumara
:
   


• If no, where will you stay
   prior to the retreat?
:


• Telephone number of your
   accommodation prior to the
   retreat? (if apply)
:


• Will you stay with us after
   the retreat?
:
Yes     No


• If yes, date of departure
   from ONEWORLD retreats -
   Kumara
:
   


• If no, where will we take
   you after the retreat?
:


• Have you been to Bali
   before?
:
Yes No


• Have you attended one of
   our retreats before?
:
Yes No


• Your Birthday
:
   


• Yoga Experience
:


• Type of Yoga
:


• Do you practice meditation
   on a regular basis?
:
Yes No


• Have you practiced
   meditation in the past?
:
Yes No


• If you have any meal
   preferences, please let us
   know:
:


• Please explain if you have
   any physical disorder that
   we should be aware of


:



• Special Request
:


How did you hear about us? (Please be specific e.g. Google, website, magazine, friend's name etc.)
:


CONSUMER DISCLOSURE NOTICE


I have read and agree to the Consumer Disclosure Notice

We will confirm your reservation within 36 hours.