Name
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First Name
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Email
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Gender
Date of birth?
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Phone
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Where will you be traveling from?
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We would love to know what draws you to this retreat?
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Is there anything about your personal journey or past experiences that you’d like us to be aware of? Your response is completely confidential, and during the retreat, you are always encouraged to share only what feels right for you.
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Have you previously engaged in practices such as Breathwork, meditation, somatic healing, kundalini activation, spinal energetics or other forms of holistic healing?
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The retreat includes deep inner work, movement, and energy practices. Are you open to exploring new experiences that may bring emotional or energetic shifts?
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Do you feel ready to commit to this journey of self-discovery and transformation in Bali?
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This retreat is a space for self-exploration and transformation. What personal intentions or themes would you like to explore?
Write as much as you feel called to share.
Have you attended a retreat before? If so, what was your experience like?
For your safety and to ensure this retreat is the right fit for you, please review the following conditions. If any apply, we encourage you to reach out so we can discuss whether adjustments or additional support might be needed. Please check any that are relevant to you:
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Please tick all that apply to you
Please list if you have any allergies and/or dietary restrictions.
Accomodation is twin share and prices are per person - payment plans available. Please initial if you agree
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Upon application approval a deposit of $700aud is required to secure your place. Please tick below how you would like the payment split?
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Please select first preference of room
All rooms are twin share - rooms are price tiered. Please note room 6 is small and would only allow for carry on suitcase per person.
I, the Participant, choose to take part in the retreat experiences with Cate Porter and Lauren Selek, acknowledging that I am responsible for my own physical, mental, and emotional well-being throughout. I understand that all practices are optional, and I will participate in a way that feels right for me.
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Securing your spot on the Synergy Retreat involves a few steps. Please read the following terms carefully: 1. Application Approval Once your application is approved, you will be eligible to secure your spot. 2. Deposit Payment A non-refundable deposit of $700 AUD is required within 7 days of application approval to confirm your spot. Upon receipt of the deposit, we will update your balance and issue an invoice based on your selected room and payment plan. Your full balance must be paid no later than 30 days prior to the check-in date. Invoices will be sent on specific dates, and timely payments are essential to secure your booking. 3. Room Pricing Pricing for the retreat is tiered based on room options. Prices range from $1300 AUD to $2500 AUD, depending on the room type. You will be able to select your room at the time of application. 4. Cancellation & Refund Policy We understand life can change unexpectedly, and we strive to be fair while protecting the integrity of the retreat for all participants. Please note the following cancellation policy: • Deposit: The $700 AUD deposit is non-refundable under any circumstances. • Cancellation More Than 75 Days Before Check-In: If you cancel more than 75 days before the check-in date, we will refund 50% of the amount paid, minus the non-refundable deposit. • Cancellation Within 75 Days of Check-In: Unfortunately, if you cancel within 75 days of the check-in date, no refunds will be issued. 5. Last-Minute Bookings For bookings made within 60 days of the retreat start date, a deposit of at least 50% of the total price is required within 48 hours of booking confirmation. For bookings made within 30 days of the retreat start date, full payment is required within 48 hours of booking confirmation. Please note that all last-minute bookings are non-refundable.
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Is there anything else you would like to share with us? If so, feel free to use this space to share
