Form cover
Page 1 of 1

Retreat Application Form

1. Fill in and submit your application. 2. Pay 50% deposit & send confirmation to marine [email protected] (please note, ceremonial donation & extra activities excludes). 3. Complete your call appointment (if needed). (NB: wait for us to send you the correct accommodation links & transport details - we'll share after you complete your application).

First Name

Last Name

What is your E-mail address ?

Phone Number

Date of Birth

Where do you live ?

Tell me more about yourself

Emergency contact name

Emergency contact number

Retreats Dates

Select all that you intend yo attend
Retreats Dates

Have you attended one of our retreats before ?

How did you hear about us ?

Do you have any injuries or medical concern ?

Do you have any special requirements?

Waiver and release of liability

I am voluntarily participating in the Retreat/s, entirely at my own risk. I am aware of the risks involved, and release and discharge any of the organisers, facilitators, agents, helpers and volunteers from and against any and all liability arising whatsoever.
By signing this form, I agree to be added to the Equilibrium into Gravity mailing list for future updates. I acknowledge that I can unsubscribe at any time.
Waiver and release of liability

Date

Signed & Name

Signature