Date of Retreat *

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DD

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Attendee Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Phone *

Country

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Next of Kin *

Who should we contact in case of emergency?

First Name

Last Name

Next-of-Kin Phone *

Country

(###)

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Choose Option *

Please note: - The retreat is priced below-cost to make it accessible to as many as possible. - There are only 2 private double rooms. Availability on a first come-first served basis. - The cost below includes 3 simple meals per day with drinks and snacks. If your dietary needs are highly specialised, please kindly bring food items needed to supplement your diet.

ZAR 4 900 - Shared Room (dormitory-style)

ZAR 5 800 - Double Room (private)

ZAR 6 700 - Pay it forward rate - Double Room (private)