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Ecstatic Awakening Registration

PLEASE NOTE: all information is STRICTLY CONFIDENTIAL and is to ensure the safety of all participants. Please be honest, taking full personal responsibility for your physical and spiritual well-being.

Step 1: Let's start with your personal details

What country do you live in?

Emergency Contact

Any known health conditions:

Food & medication allergies:
Please list any food allergies for our chef
COVID: By confirming to participate in a retreat, you acknowledge and take full responsibility of the risk. We as facilitators and retreat locations endeavour to follow Covid protocol guidelines to the best of our ability with respect and conscious responsibility. Should you feel symptomatic, please don’t come to the retreat.
Waiver and release of liability
Signature