Disconnect to Connect Retreat Application Form
A Nourishing Week of Healing Your Mind, Body, And Spirit through acceptance and compassion Fri Jan 20, 2023 — Thu Jan 26, 2023 Wiltshire, UK
Your name, please
Date of birth
Mobile number (provide country code if outside UK)
Are you coming alone?
Who is your room partner, if accompanying:
Do you suffer from any health conditions, injuries or disabilities?
Do you have any allergies:
Tell us about your meditation or yoga experience, if any:
Retreat dates attending
7 days retreat: 20-26 Jan 2023
Based on the accommodation types available, which one do you require?
Single room (Sold out!)
2 individuals sharing (Sold out!)
3-4 individuals sharing (same gender) - 1 space left!
2 individuals sharing (male only & no en suite) - 1 space left!
I have a gift voucher
Inform me if there is one
By which means are you planning to pay? 30% Deposit required to secure your space!
By bank transfer (will email you account details)
By cash (in one of our locations)
How did you hear about our retreat?
Anything you'd like to know?
We look forward to meeting you soon!