Silencia Enrolment Form

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ENROLMENT FORM

Thank you for your interest in joining us on Samothrace in September.

To ensure that we can best support your journey during the immersion, along with your personal details, we have asked a few more in depth questions.

The information on this form will be kept fully confidential and only shared with Rose and her immediate team involved in the immersion.

As this is an intimate immersion on private land, we require a connection call prior to confirming the booking. This is also an opportunity to ask any questions. Book a time via Calendly here.

Please find a link to the Booking Terms and Conditions here.

For any questions email: [email protected]

We look forward to welcoming & supporting you.

with love,

Rose

Name

Date of Birth

Where are you currently based? Where will you be travelling from?

Phone Number

What is calling you to Silencia?

Have you attended an immersion before? Or do you do any regular self-care practices or modalities? And if so, which ones?

Do you have any medical conditions / health concerns or injuries we should be aware of? Note this includes physical, emotional and or mental concerns

Please list any special dietary restrictions or allergies:

How did you hear about this immersion?

I have booked a connection call with Rose.

I have read, understood and agreed to the Booking Terms and Conditions.

I am ready to pay to secure my space.

Leave a Note or Question for us.

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Join Our Free Trial

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