Deep Emotional Healing Retreat – Application Form

Thank you for your interest in the Deep Emotional Healing retreat.

To give yourself the best shot at getting one of the 7 spaces available, please complete your full application and be as detailed as possible. In other words, put your all into it and give me something to work with. Let's get started...

Why are you interested in attending this retreat?

Share your goals, context, and challenges you are facing.

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What is the specific emotion/pattern/block/challenge you want to work on?

We want to understand what you are specifically looking to address during the retreat.

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Which products have you purchased?

List any products or services you've engaged with, if applicable.

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What other courses, programs, and experience do you have?

Share your background in inner work, self-healing, or emotional regulation.

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Space is very limited (I’ve only got 7 total spots available, some already reserved). I want to make sure this is a good fit. Why should I choose you?

Share why we should give you a spot and what positive contributions you will bring.

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What hesitations do you have about joining the Emotional Deep Healing Retreat experience?

If you don't have any hesitations, why not?

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Last question: the price for this once-in-a-lifetime experience is $4,800 per person (private room, all-inclusive except travel) – please check yes if you are willing to pay this amount within 48 hours of your application being accepted.

(This is not a commitment, I just need to know you’re serious so I can follow up with you.)

Yes, I can pay in full.

Yes, but not in full - I need a payment plan.

I'm willing to share a room for a 25% reduction.

I am not sure.

No.

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First Name

Please enter your first name.

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Last Name

Please enter your last name.

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Age

Please enter your current age.

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Country

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Email Address

Please enter a valid email address for communication.

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Confirm Email

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Phone Number

Please enter your phone number.

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