5Rhythms workshop enrolment/ enquiry

This retreat/workshop appeals to me because *

My secret wish... what I most deeply yearn to receive from attending this workshop *

Any anxieties, worries, niggles *

Please briefly list any health issues (specifics about each of these:physical, emotional, mental), and what your needs to do with these would be on the workshop *

Are you taking regular medication? *

I have paid... Wild Heart. Bsb 016494 Acct 598969157. *

Deposit $500 to hold my place Earlybird full payment $1390 by Feb 28 Full workshop payment $1590 after feb 28 I haven't paid anything yet I need a payment plan please

Comments or questions *

Emergency contact name and email or phone *

My relationship with my sexuality is *

Write a little bit about your sexual history... joys, fears, traumas and a-ha moments, and how you've worked with these over your life. This helps us tailor the workshop to meet your specific needs. *

My relationship with power is *

My relationship with my Vision is *

Food allergies, intolerances, preferences. Please BE SPECIFIC... if you don't tell us, we can't meet your needs :) Karina and Tora are absolute goddesses in the kitchen, and we want you to swoon every meal. *

Any covid-related anxieties, questions, needs? *

Are you happy to share a room/ sleeping space, or will you bring a tent to ensure isolation? *

I'll bring a tent Share room/space is fine Not bothered either way

5Rhythms
ENROLMENT /ENQUIRY

Yes! I would like to register for a 5Rhythms® workshop
or just ask some more questions

If you are registering for a workshop, please fill in the whole form, then pay your deposit

5Rhythms ​ENROLMENT /ENQUIRY

Yes! I would like to register for a 5Rhythms® workshop​or just ask some more questionsIf you are registering for a workshop, please fill in the whole form, then pay your deposit

5Rhythms
ENROLMENT /ENQUIRY

Yes! I would like to register for a 5Rhythms® workshop
or just ask some more questions

If you are registering for a workshop, please fill in the whole form, then pay your deposit