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317-701-4916

Make a Payment

At JCI we have worked to make payment options easy and user friendly. Please utilize the form below to register for a Bloom Sacredly Retreat. To pay your deposit regarding other JCI services, please navigate to the JCI link at the bottom of the page. All remaining balances will be sent via invoice.

Complete the following form to sign up for the Bloom Sacredly Retreat today!

First name*

Last name*

Email*

Phone*

Which retreat are you interested in attending?*

Brazil March 2027

Bali September 2027

Future retreats not yet advertised

How did you hear about Bloom Sacredly?

Social Media

Friend/Referral

Website

Professional networking event

Have you previously traveled outside of North America?*

Yes

Is there a specific person that you want to room with? If so, please list their name. *

How open are you to trying various cultural activities?*

Very open

Somewhat open

Neutral

Not completely open

Not open at all

How open are you to trying food that is safely prepared but not American based?*

Very open

Somewhat open

Neutral

Not completely open

Not open at all

How comfortable are you with participating in group activities?*

Very comfortable

Somewhat comfortable

Neutral

Somewhat uncomfortable

Very uncomfortable

How well do you get along with others?*

Extremely well

Well

I can tolerate others

Not well at all

Do you have any physical challenges that might impact your ability to fully engage in all activities?*

Yes

I am unsure

If you have any anxiety related issues centered around travel, please share what that looks like and how it shows up for you.*

Please share any fears or phobia's that could impact your ability to fully engage in this retreat.*

Retreat Deposit*

Bloom Sacredly Deposit$250

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