Back to Self Bali | Jan 2 - 6, 2024 
Thank you for your interest in the Back to Self Bali: Reconnecting with your Body, Nature and a Community of Wise Women. Get ready to pack your swimsuit, leave the to do lists at home, and embark on a body-based journey to healing, connection and rediscovering your inner wisdom and joy. We will re-member how to fully rest, re-balance our nervous systems and let go of old patterns, learn how to embody our boundaries and discover how to balance feminine and masculine energies to create a fulfilling and nourishing New Year. All of that - while experiencing the magic of Water Temple ceremonies, sound healing rituals, local steam saunas and bon fires under Balinese stars.    
    
For this first iteration of Balinese version of this workshop, we are selecting an intimate group of amazing young women to join us in this magical Balinese jungle. We would love to get to know you a little bit.
Sign in to Google to save your progress. Learn more
Name 
Surname
Email
Phone (with country code)
What's your age? *
Which country currently live in? (or will be flying from)  *
Now tell us a little bit more about You 
Why are you interested in the "Back to Self" now? Is there anything happening in your life that inspired that? 
What are some of your intentions for the workshop? What are you hoping to experience? 
Do you have any practices that help you co-regulate today? If so, what are those? (Totally fine if not, just learning about you!)
Did anyone refer you? If so, add their name 
We will be staying at Prashanti Retreat Center, nestled in the middle of the rice fields north of Ubud
Which of the accommodation options are you interested in for Jan 2 - 6th? (Food is not included, but many yummy cheap options around).  *
Captionless Image
Would you like to book an extra night before or after the retreat? We start on Jan 2th early morning and end Jan 7th late in the evening. Extra nights will need to be booked directly with the Eco hotel. We will send you contact details
Are you interested in booking 3 day ayurvedic Detox before the training? If so, which dates? The booking will be done with the ayurvedic clinic directly. We will send you contact details.  
Do you have any questions for us?
Thank you. We will be in touch soon. 
And hope to see you - in Bali! 
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms