In order to register for The Healing Heart of Bali retreat, please scroll down and
complete the form below:

If you have technical difficulties with this form or have additional questions, you can contact Laura’s assistant, Jen, by email at jpeachtree23@gmail.com or call 330-421-0111 (Jen is on Eastern Time and is available most weekdays from 7 am PT/10 am ET until 3 pm PT/6 pm ET).

Bali Double Registration 2025 - Stage 1

"*" indicates required fields

Name*
Email Address*
Billing Address (exactly how it appears on your credit card bill).*
Mailing address for retreat business (if different).

Payment

Retreat Options (Each Price Listed Is Per Person)*
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Credit Card
MasterCard
Visa
Supported Credit Cards: MasterCard, Visa
Expiration Date
 

Terms and Conditions

Please take a moment to access the terms and conditions, health and safety policy, and cancellation policies for this trip. Then return here to complete your registration. The terms and conditions and cancellation policy for this trip can be viewed here. The health and safety policy can be viewed here. (Links will open in a new window/tab).

Agreement*
I HAVE READ AND AGREE TO THE HEALTH AND SAFETY POLICY, THE CANCELLATION POLICIES, AND THE TERMS AND CONDITIONS FOR THE HEALING HEART OF BALI TRIP. If this field is not ticked, you won't be able to proceed and complete your registration.
Would you like to be added to Laura's email list?*
This field is for validation purposes and should be left unchanged.

Please note: The system will take a moment to save your registration; please do not navigate away from this page while it saves. Once your registration is saved, the system will direct you over to Stage 2.

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