A REAL ESCAPE Luxury Ascension & Yoga Retreat in Bali Registration Form
Please complete this registrationform. This is needed, along with your deposit to ensure your reservation. Please know that it is strictly confidential and this information is only used in case of an emergency.
21st-26th, October 2019
Treat yourself to a Luxery wellbeing retreat in Bali with Sharron and Maria. A time for you to rejuvenate and relax.
Name: *
Your answer
Address: *
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Country: *
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Nationality: *
Your answer
Date of Birth: *
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Phone (Mobile): *
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E-Mail: *
Please be sure that you enter your email correctly.
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Choice of occupancy at Spa Village resort
Occupancy *
Required
Name of the person sharing room with:
Your answer
Airport transfer and extra nights
Please note that a maximum of one transfer per room from and to the airport, is included in the price.
Please state arrival details for transfer *
Please state airport number, date and time of arrival at Denpasar airport. If you wish to be picked up somewhere else close to the airport or in Ubud please provide adress, date and time. The retreat will officially start at 3 pm on Monday 21st.
Your answer
Please state departure details for transfer *
Please state airport number, date and time of departure at Denpasar airport. If you wish to be dropped off somewhere else close to the airport or in Ubud please provide adress, date and time. The retreat will officially end with lunch on Saturday 26th.
Your answer
Dietary Needs
Dietary Requirements: Due to allergies, intolerances, or medical needs. *
Tick what matches your dietary needs.
Required
Course Fee
1.570 USD all inclusive for twin share and 1.970 USD single occupancy. Non-refundable deposit of 450 USD (twin share) and 750 USD (single) due upon booking. *
Conversion rate is calculated by the time of payment.
Please state the date of your payment and use bank details below. Your reference: "Bali October + your name" *
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Contact Details in Case of Emergency:
To best assist you in case of emergency, we ask that you provide us with the following information:
Name of Contact Person: *
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Relationship to Contact Person: *
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Contact Phone Number: *
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Medical Information:
Please let us know of any medical conditions that have occurred in your life: *
Required
Describe these conditions and any nessesary precautions needed during the retreat. *
Please be specific, especially about allergies or mental illnesses.
Your answer
Terms and Conditions of Attendance
Maria Linghult (Aja) and Sharron Hopley (Rajni) hereby commit to provide the meditation tuition through the established methodology. The Bright Path Ishaya programs are educational experiences and are not to be mistaken for medical or psychological counseling or treatment.

Maria Linghult (Aja) and Sharron Hopley (Rajni) are not responsible for injury or loss arising in connection with program participation. As well they are not to be held accountable in cases of theft, physical damage or accidents suffered by any participant along his or her stay during the course. Please not that valid travel insurance are required for taking part of this retreat.

Declaration
I declare that I understand and agree to the Terms and conditions of attendance as stated above and hereby state my will to take part in the Luxury Ascension Bali Retreat at Tembuk Spa Village Resort from 21-26 October 2019, which will be conducted by Maria Linghult (Aja) and Sharron Hopley (Rajni).
SIGNED: *
Please enter Participant's Legal Name as your Signature.
Your answer
Please enter the date of agreement to the Terms and Conditions and your Declaration. *
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Please press SUBMIT at the bottom of the page to complete your registration.
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