Book Your Spot in Our Pauline Rogers’ Mystery Quilt Bali Retreat 2024

Name

First Name

Last Name

Preferred Name

Phone Number

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Select Your Retreat Date

Select Your Room Type

We do not buddy up people. You must have a friend to share with.

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone

Where did you hear about us?

If others, where exactly did you hear about us?

Acknowledgment

I have read and agreed to the terms and conditions, and deeds of acknowledgment to this retreat