Registration Form
Please PRINT/ all information CLEARLY or Type
PERSONAL INFORMATION
Name_______________________________________________________________
Birth Date________________________________________________
Address____________________________________________________________
_____________________________________________________________________
City________________________________________
State___________________ Zip___________________
Primary Contact Phone _____________________________________ Fax_______________________________________
Email or Web Address _________________________________________ _____________________________________________________________
Which retreat are you registering for
Ancestral Journey of the Heart Dec 28- Jan 6,2019______________
Bali Sacred Immersion Feb 13- 25,2019_______________
Journey of the Heart :Bali Bliss Mar 13- 25,2019_____________________
Deposit paid Amt.____________ Date ________________________
by check _________________
by Bank transfer________________
by money order mailed _________________
by Pay pal____________________
I would like a single room (additional fee $30 per day for melatti cottages) _______________________
Additional fee for Ananda cottages is $45 per day__________________
Please return this signed Registration Form by either e-mail or post as soon as you can, no later than One month before each retreat
to: Heart of the Jungle, Inc.
PO Box 1567, Makawao, HI 96768, USA
E-mail:Sol33king@gmai.com
Your investment for
Bali Sacred Immersion $2600
Ancestral Journey of the Heart $1900 after Nov 15 $2200
JOURNEY OF THE HEART $2300
some discounts for early registration contact me for details
$500 deposit will reserve your place
Balance due in bali
Please make checks or money orders to Heart of the Jungle, Inc send to PO Box 1567 Makawao, HI 96768 USA
Bank Transfer info to include on document as Follows:
Name on Account: Heart of the Jungle,Inc
Checking account number: 0004 285999
Routing Number: ABA NO. 121301028 Swift Code BOHIUS77
Bank of Hawaii Pukalani, HI 96768
Pay Pal info: Use this e-mail address: Sol33king@gmail.com – Heart of the Jungle,Inc. This will access my account and the funds will be deposited ALL FEES to be paid by you
Please send a Confirmation E-Mail to
sol33king@gmail.com
ALL funds in US Dollars
This includes:
*airport pickup and driving to hotel
*all lodging (double occupancy)
*ground transportation in Bali
*pure drinking water
*most meals(we will have Several free evenings or days)
*all temple entrance fees
*all performances
*all the Teachings, classes and dances
*one Massage with Healing herbs and hot flower bath
What this does not include:
*Air fare to Bali
*drinks other than pure water
*tips to staff (hotel and drivers)
*any other massages or healings
*return drive to airport(approx $25 arranged thru Solomon)
All rooms are double occupancy, all rooms have an overhead fan All breakfasts are at our Hotel
All meals will be buffet style with lots of choices. Let us know your meal preferences on Registration form.