Registration

REGISTRATION FORM

Ibiza, January 17th -21st 2025

First Name

Last Name

Surname

Your Email

WhatsApp Number

Date and time of Birth

Day

Month

Year

Time

HoursMinutes

City, Country of Birth

City, Country

Which room are you interested in? (Dependent on availability at the time of the registration request)

Deluxe Room - Shared (€2,800)

Deluxe Room - Only for me (€3,300)

Elite Room - Shared (€3,000)

Elite Room - Only for me (€3,700)

Master Bedroom - Shared (€3,450)

Master Bedroom - Only for me (€4,200)

Let us know a little about yourself and why you wish to join this retreat

Multi choice

I have NOT taken any anti-depressant medication for at least 6 months (all SSRIs)

I understand that there is a 2 week diet protocol prior to the retreat, that if not respected, will compromise the group and my own experience.

I will not in-take any alcohol, stimulators (natural or synthetic of any kind) for at least 10 days before the retreat.