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Bali 
September 2023 
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Full name: *
Email *
Where do you call home? (Address please) *
Date of Birth (dd/mm/yyyy) *
What does self-love look like for you right now in your life? *
What would be your greatest intention for yourself entering this retreat? *
Why does this retreat call to you? *
Do you have a mental or medical condition that we need to be aware of? Note- This could be physical, mental or emotional.  *
Have you been on a retreat before?
If you have instagram, let us know your handle so we can connect!
Your preference for accommodation 
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