Chakra Balancing Retreat
March 19 - 22, 2026
Name
*
First Name
Last Name
Date of Birth
*
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Month
-
Day
Year
Date
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
The investment for this retreat is $3,400. Please confirm your understanding and agreement to pay this amount in-full prior to this Retreat in order to attend by writing "I AGREE" in the text box below.
*
Please select a Payment Plan option:
*
Pay In Full: $3,400 USD
$500 Deposit + $2,900 by December 1st, 2025
My Products
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Option 1: Pay in Full
$
3,400.00
Quantity
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Option 2: $500.00 Deposit
$
500.00
Quantity
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Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please confirm your understanding that upon submission of this contract, your initial payment (as indicated above) is due upon receipt and that all payments are non-refundable.
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Yes, I understand.
No, I can't make the initial payment right now. *If this is the case, your application will not process until after you've had a conversation with our financial department.
Please confirm your understanding that coming to this retreat held in Austin, TX is your responsibility and if you are unable to attend the retreat for any reason, all payments are still due in-full and are non-refundable.
*
Yes, I understand and agree.
No, I cannot make this agreement at this time.
Signature
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Submit
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