apply to attendThe Breath of Bali: A retreat of breathwork, wellness, and adventureDecember 6 -13, 2025 Name * First Name Last Name Email * Phone * Country (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Age What is your social media handle? Preferably, Instagram. Describe yourself in 3 words... What do you do for work? What is your zodiac sign? If money didn't matter, what would you be doing with your life? Which accommodations are you interested in? * Shared Room Solo Room Any Have you ever been to a retreat? Yes No Why do you want to attend this retreat? What is your intention? * What is your current experience with spirituality, meditation, breathwork, or similar practices? Have you practiced breathwork before? Yes No If yes, please describe your expereince Is there anything specific you would love to experience during your time in Bali? Where will you be flying from? Are you planning to stay in Bali before or after the retreat? * Yes No Undecided If yes, please share your dates Emergency Contact Name + Number * Dietary restrictions or food allergies * Do you have any medical conditions we should know about? Are you on any medications we should be aware about? * If applicable, please describe any mental health conditions * I understand that my deposit & any additional payments towards the retreat are non-refundable * Yes No I understand that the full price must be paid BEFORE the retreat begins * Yes No Thank you! Mel will be in tough with next steps based on your acceptance for the retreat.