Fresh Start Cleansing Retreat

Please select your options:

Retreat in Ubud schedule for 2010 on:

March 06 - 13, 2010
November 28 - Dec 5, 2010


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 participants 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


• 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


• Are you a vegetarian?
:
Yes No


• Do you have allergies or
   some food you dislike?
:
Yes No


• If yes please enumerate
:


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


:



• Special Request
:


How did you hear about us...?
:

Please  Specify:
(Such as Google, Magazine, Web Link, etc...)


CONSUMER DISCLOSURE NOTICE


I have read and agree to the Consumer Disclosure Notice

We will confirm your reservation within 36 hours.