The Raw Connection Retreat 2 (registration form)
Welcome to our second fully Raw Emotional Healing retreat! :)

To make this experience smooth for everybody we kindly ask you to answer the following questions about the food, accommodation and health.
Email address *
Your Name *
Your answer
Link to your Facebook profile :) *
Please mark going on the event, or if you prefer not to do that, than pleas give us a link to your social media account
Your answer
What is your main motivation to join the retreat and what are the most important things for you? *
Choose the things that resonate with you the most and write us more in the "OTHER" box. This will help us understand your needs and adjust the program in a way that feels good for all of us. :)
How did you hear about the retreat?
Would you like to stay 2 days longer to experience fasting? *
1 day of water fasting (Monday) and 1 day of juice fasting (Tuesday)
Where would you like to sleep? *
Below prices are for the first 3 days. Additional costs apply for the 2 extra days.
Special requests regarding food (allergies/intolerance/special diet etc):
Your answer
Do you currently suffer or have you suffered in the past 3 years from a physical or mental illness that requires medication or professional support? If yes, please specify. *
Your answer
Further support during the retreat:
In this kind of retreat we may go into a deep healing process that may take a long time, and require special care. As we are only two organizers we don't always have the capacity to take care of individual cases during the program. Therefore we recommend that if you are in a space of needing constant support, help, or feeling unstable, that you register for private assistance. We have specialists in emotional healing ready to support you during the retreat in case of acute emotional need, and also for voluntary private sessions. Price is 97 euro for the first 2 hours and 50 euro for each additional hour, with a maximum cost of 350 euro per day.
More info / other requests:
Your answer
You can send the full payment or a deposit* of 150 euro to this account:

Bank transfer:
Alsamman, Rami
DE67 1005 0000 1065 0592 36
pay with PayPal ( there is 6 Euro fee from PayPal)

TERMS AND CONDITIONS, by registering you agree to the following

* the rest of the payment to be paid in cash at the time of arrival.
I will do the payment using *
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy