Please complete the form below and pay the deposit of $750 through our secure payment process driven by PayPal. This will secure your place with us at Surf Haven retreat, Bali. PLEASE ENSURE YOU HAVE A BOOKING HOLD IN PLACE BEFORE PROCEEDING WITH THIS BOOKING. If you need to check availability first please click on the 'check availability' button below

First Name:* Last Name:* Birth Date (DD/MM/YYYY): Email Address:* Phone Number:* City:* Country:* Emergency Contact Name:* Emergency Contact Number:*   Retreat Date:* 2012 Oct 5 ~ 11 2012 Apr 1 ~ 7 2012 Apr 8 ~ 14 2012 Apr 22 ~ 28 2012 May 12 ~ 18 2012 May 19 ~ 25 2012 Jun 2 ~ 8 2012 Jun 11 ~ 17 2012 Jul 2 ~ 8 2012 Jul 10 ~ 16 2012 Jul 16 ~ 22 2012 Jul 23 ~ Jul 29 2012 Aug 5 ~ 11 2012 July 29 - Aug 4 2012 Aug 11 ~ 17 2012 Aug 19 ~ 25 2012 Sept 1 ~ 7 2012 Sept 22 ~ 28 2012 Oct 12 ~ 18 2012 Oct 20 ~ 26 Accommodation Type:* Triple Share Twin Share Private Room Travelling with a friend(s):* NoYes   Surfing Experience:* Please select one option from the following: Never surfed before/beginner surfer (less than 10 times) Novice surfer (10-50 times) Intermediate surfer (50-100 times) Advanced surfer (100+ times)   Yoga Experience: Please describe your yoga experience (if any):   Spa Treatment Options:* Please select your preferred 2 hour treatment (click on the name to read more about each option) Note: Your other spa treatments will be scheduled on your arrival at the retreat Bali BlissBody TonicBody Revolution   Surf rash vest size:* (please bear in mind these should fit securely) XSSMLXL Sarong Colour Preference:* Light BlueDark BlueYellowRedGreenBlackPinkPurple   Medical/Health Conditions we should know about:   Dietary/Food Allergies we should know about:   Any Special Events over the retreat we should know about:   Travel Arrangments: Are you arriving into Bali (DPS airport) on the first day of the retreat on a flight?:* NoYes   Will you require a hotel pick up on the first day of the retreat?* Note: our transfer zone will apply. We will email you with pick up time or villa address if you are outside our transfer zone. NoYes   If you have not made travel arrangements to Bali please check this box and send us this information at least a month before your retreat date. I have not made any travel arrangements will send info later   What are your plans for the last day of the retreat?* I have not made plans, will send info laterI have made plans   Retreat Goals What do you want to have achieved by the end of the week?   How did you hear from us?* Word of Mouth   Magazine   Newspaper   Website / Internet Search   Other   Yes, I would like to receive special offers, news and updates I confirm that I am at least 18 years of age and I accept the Terms and Conditions *indicates required fields Bali Bliss (2 hour treatment) This treatment begins with a hour long Balinese massage, then the entire body is painted in a brown, granular paste (the traditional Javanese "Lulur"), containing turmeric, sandalwood, cinnamon, ground nuts and rice. The paste is then gently rubbed to exfoliate the skin. After a quick shower, cool, fresh yoghurt is splashed, then smoothed over the skin. The yoghurt's enzymes stimulate cell activity and restore the PH balance of the skin, it feels soft as a silk after the yoghurt is washed away. The final step involves luxuriating in a fragrant, warm, flower filled bath. 2 hours of pure Bali bliss. Body Tonic (2 hour treatment) Crème bath with scalp massage plus blow wave + manicure or pedicure. Our therapists wash your hair followed by a long, relaxing head, neck and shoulder massage easing away all tension. A conditioning cream matched to your hair type is applied. The cream penetrates your hair with the help of a hair steamer and a blow wave produces a shiny, silky mane. The crème bath is followed by your choice of either a manicure or pedicure including a relaxing hand or foot massage. Body Revolution (2hour treatment) This combines both our signature massage and facial. The treatment starts with a deep cleansing facial using essences of rose, ylang-ylang and lemon, depending upon your skin type. Next is a skin conditioning mask and a hand and arm massage. This relaxing facial will leave your skin glowing. Following this is a one hour full body massage using a blend of essential oils from Indonesian spices and flowers. Our massage therapists incorporate a variety of techniques to relax every day muscular tension, aches and pains. This unique treatment has been designed to fully restore and rebalance the body.