Registration Form

Please PRINT/ all information CLEARLY or Type



Birth Date________________________________________________




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


Your investment for

Bali Sacred Immersion  $2600

Ancestral Journey of the Heart  $1900  after Nov 15 $2200


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: – 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

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.