Bali Retreat Form | Yoga with Amber ॐ

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Soul, a Silent Retreat Bali Application

To apply, please take the time to fill out the information below, and in the next steps.

*Please be patient as this form might take a moment to navigate between steps.

*If you experience any issues with this form please reach out on WhatsApp / Email

First name

Last name

Email

Date of Birth

Phone (+ country code)

WhatsApp Number if different from your phone number

What gender do you identify as? *

Female

Male

LGBTQIA+

Other

Emergency Contact. Name & Phone Number

How did you hear about this retreat?

Where are you traveling from?

Tell me a little bit about yourself and the reason you would like to join this retreat

Please upload a photo of yourself

Upload File

Upload supported file (Max 15MB)

What do you currently do for work?

Have you ever practiced Yoga/ Meditation/ Anapana/ Vipassana? if so, describe (it's ok if you haven’t)

What do you consider your greatest strength?

What do you consider your greatest weakness?

Why would you like to attend the retreat, choose your priorities

A phone and screens detox

I always wanted to learn Vipassana but was nervous

I need time for myself

I never meditated and always wanted to learn how to meditate

I want to deepen my yoga and meditation practice

I experience PTSD or other mental stress and want to learn tools to flow with life with ease

I want to work on my subconscious mind

Learn to calm my mind and observe the reality as it is

Learn the Buddha’s powerful techniques, to liberate from patterns of behaviour, conditioning and traumas.

Enhance my self love and my love and compassion to all living beings

New Astrological Year, Equinox & Eclipse Season Ceremony

What are you hoping to get out of this retreat?

Are you attending alone or with someone you know? If not alone, please specify.

What questions do you need answered before you can commit to the retreat?

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