Workshop Application Form

Please choose the event for which you are applying:*

Please choose which you would like to attend:*

No extra charge for attending all 3!

Staff Level (for those taking staff workshops)

Please choose the level of instruction which best suits you. Verify your level using the "Prerequisite Videos" page

Personal Info:

Name*

First Last

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Date of Birth*

Gender*

Profession

Passport Information:

Country of Residence

Emergency Info:

Emergency Contact Name*

Relationship*

Telephone*

Medical Concerns

Hotel Info

Accommodation:

Room Preference*

Room Preference (Bali)*

Which type of accommodation would you like? Total Retreat Price is determined by which type of accommodation you choose. Please refer to the section on Retreat Pricing on the event page for details.

Room Sharing 1 (Bali)*

What is your preference for sharing accommodation?

Room Sharing 2 (Bali)*

Are you coming alone or with friends (friends/ partners/ family)? If sharing, are you looking to share with other retreat participants whom you are yet to meet?

Roommate Request

Questions/ Comments about Accommodation:

Additional Info

Musical Preference

We'd like to take your musical preference into account when making our playlists. Please name your favorite 3 musical styles or groups.

Questions/ Comments:

How did you hear about the retreat?

A non-refundable deposit is required to reserve your space for any program. Upon submitting this application, you will be redirected to a payment page where you may pay via direct bank transfer or paypal.Applicants must be 18 years of age by the retreat start date. Fusion Arts makes every effort to ensure the safety of its students. That said, Fusion Arts is not responsible for any injury, property damage or loss which might occur to students while attending any of the workshop or retreat activities or while traveling in or around the workshop or retreat location. By submitting this form to Fusion Arts you are declaring that you have read and agree to this statement as written and intended.Please read the Terms & Conditions below, which apply to all applicants.

Agreement*

I have read & agree with the Fusion Arts Payment and Cancellation Policy

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Agreement*

I have read & agree with the Fusion Arts Payment and Cancellation Policy