Retreat Registration Form | Amethyst Temple

Your Love is King Couples Retreat

Full Name & Age

Phone

Why are you interested in attending this retreat?

Do you both have passports? (must be valid for 6 months after date of retreat)

Do either of you suffer from any illnesses that we should be aware of? If so, please list

Are either of you on any prescribed medications that need to be taken regularly? If so, please list

How would you rate your mental and emotional state on a scale of 1-10 (1 being outstanding, 10 being highly unstable)

Admission fee for this retreat is $6500 per couple. Payment plans are available with full payment due by 2/17/2022. Completing this Registration will be followed up by an email with payment options.

Thanks for registering!