Healthcare Practitioners Retreat

Confirm Email *
Gender *
Country *
Birth Date *
Emergency Contact Person *	Please write the full name of someone that can be reached in an emergency. Please do not write your own name.
Relationship to Emergency Contact *	Are they your brother, sister, mother, father, friend, etc?
Emergency Contact's Phone *
Emergency Contact's Email Address *
Country of residence of Emergency Contact Person *
Dietary Preference *
Special Dietary Requirements/Food Allergies
Do you know anyone else attending this retreat?
How did you hear about us? *
Why are you applying for this program? Please be generous in your answer. *
Please share about any personal work (including therapy, yoga, meditation, process groups, transformational experiences) that you have done so far in your life? *
What is your area of practice/profession? *
What educational qualifications/certifications do you have and how many years of experience do you have working in your field? *
How many clients/patients do you see per week? *
If you have one, please include a link to your professional website:
$1 Deposit Upon Application *	I understand that my credit card will be charged $1 upon sending the application and that if my application is not selected, the $1 will be refunded to my card. If my application is approved, my card will be automatically charged for the 50% deposit.
Payment Terms *	I understand that my balance must be paid in full by at least 6 weeks prior to the start of the program to guarantee my space and the Temple will charge my credit card automatically for the outstanding balance 6 weeks prior to the start of the program if it is not paid before then.
Retreat Cancellation Terms *	I understand that in the unlikely event that the Temple of the Way of Light is forced to cancel any programs for any reason due to circumstances beyond their control (the only time this has happened in 17 years of operation was in 2020 due to the pandemic and border closures in Peru), all registration payments will be transferred to personal credit to be used for a future program at a later date within 2 years of whenever the Temple would be able to reopen. Refunds may not be possible in this circumstance.
Booking Agreement *	I agree NOT to book flights or make travel plans until my application has been approved. I understand that my registration is not confirmed until my application has been reviewed and approved by the Temple AND my deposit has been paid.
Travel Insurance Recommended *	I understand that the Temple strongly recommends flight and travel insurance to cover all contingencies and nonrefundable deposits and expenses.
Cell Phone Policy *	I acceptView Cell Phone Policy
Terms and Conditions *	I accept the full terms and conditions, attest that all information is accurate and accept full legal & personal liability for joining this retreat, protecting the Temple from all legal liability.View Terms and Conditions
Email newsletter	Please add me to the newsletter mailing list.

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