Apply to AttendThe Breath of Bali: A retreat of breathwork, wellness, & adventureDecember 6-13, 2025 Name * First Name Last Name Email * Phone (###) ### #### Age What do you do for work? Have you ever been to a retreat? Yes No Which accommodations are you interested in? Shared Room Solo Room Any What is your social media handle? Preferably, Instagram. Why do you want to attend this retreat? What is your intention? * If money didn't matter, what would you be doing with your life? Describe yourself in 3 words... What is your zodiac sign? Emergency Contact Name + Number Do you have any medical conditions we should know about? Are you on any medications we should be aware about? * If applicable, please describe any mental health conditions * Dietary restrictions or food allergies I understand that my deposit & any additional payments towards the retreat are non-refundable Yes No I understand that the full price must be paid BEFORE the retreat begins Yes No Thank you! Mel will be in tough with next steps based on your acceptance for the retreat.
