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Last name
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Please select your food preference. If you have allergies, or a spesific rplease specify at the bottom of this form.
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Please Select
Meat
Vegetarian
What is your gender
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Male
Female
Room sharing gender preference
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Other attendees, same gender
Other attendees, gender doesn't matter
My friend(s)/partner
Private bedroom
I'm bringing my own tent or camper
Please add your WhatsApp Phone Number, if you want to be added to the WhatsApp group with all attendees (we'll post all updates there, reccommended!)
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Azerbaijan (Azərbaycan)
Bahamas
Bahrain (البحرين)
Bangladesh (বাংলাদেশ)
Barbados
Belarus (Беларусь)
Belgium (België)
Belize
Benin (Bénin)
Bermuda
Bhutan (འབྲུག)
Bolivia
Bosnia and Herzegovina (Босна и Херцеговина)
Botswana
Brazil (Brasil)
British Indian Ocean Territory
British Virgin Islands
Brunei
Bulgaria (България)
Burkina Faso
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Canada
Cape Verde (Kabu Verdi)
Caribbean Netherlands
Cayman Islands
Central African Republic (République centrafricaine)
Chad (Tchad)
Chile
China (中国)
Colombia
Comoros (جزر القمر)
Congo (DRC) (Jamhuri ya Kidemokrasia ya Kongo)
Congo (Republic) (Congo-Brazzaville)
Cook Islands
Costa Rica
Côte d’Ivoire
Croatia (Hrvatska)
Cuba
Curaçao
Cyprus (Κύπρος)
Czech Republic (Česká republika)
Denmark (Danmark)
Djibouti
Dominica
Dominican Republic (República Dominicana)
Ecuador
Egypt (مصر)
El Salvador
Equatorial Guinea (Guinea Ecuatorial)
Eritrea
Estonia (Eesti)
Ethiopia
Falkland Islands (Islas Malvinas)
Faroe Islands (Føroyar)
Fiji
Finland (Suomi)
France
French Guiana (Guyane française)
French Polynesia (Polynésie française)
Gabon
Gambia
Georgia (საქართველო)
Germany (Deutschland)
Ghana (Gaana)
Gibraltar
Greece (Ελλάδα)
Greenland (Kalaallit Nunaat)
Grenada
Guadeloupe
Guam
Guatemala
Guinea (Guinée)
Guinea-Bissau (Guiné Bissau)
Guyana
Haiti
Honduras
Hong Kong (香港)
Hungary (Magyarország)
Iceland (Ísland)
India (भारत)
Indonesia
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Iraq (العراق)
Ireland
Israel (ישראל)
Italy (Italia)
Jamaica
Japan (日本)
Jordan (الأردن)
Kazakhstan (Казахстан)
Kenya
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Kuwait (الكويت)
Kyrgyzstan (Кыргызстан)
Laos (ລາວ)
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Lebanon (لبنان)
Lesotho
Liberia
Libya (ليبيا)
Liechtenstein
Lithuania (Lietuva)
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Macedonia (FYROM) (Македонија)
Madagascar (Madagasikara)
Malawi
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Maldives
Mali
Malta
Marshall Islands
Martinique
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Mauritius (Moris)
Mexico (México)
Micronesia
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Monaco
Mongolia (Монгол)
Montenegro (Crna Gora)
Montserrat
Morocco (المغرب)
Mozambique (Moçambique)
Myanmar (Burma) (မြန်မာ)
Namibia (Namibië)
Nauru
Nepal (नेपाल)
Netherlands (Nederland)
New Caledonia (Nouvelle-Calédonie)
New Zealand
Nicaragua
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Nigeria
Niue
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North Korea (조선 민주주의 인민 공화국)
Northern Mariana Islands
Norway (Norge)
Oman (عُمان)
Pakistan (پاکستان)
Palau
Palestine (فلسطين)
Panama (Panamá)
Papua New Guinea
Paraguay
Peru (Perú)
Philippines
Poland (Polska)
Portugal
Puerto Rico
Qatar (قطر)
Réunion (La Réunion)
Romania (România)
Russia (Россия)
Rwanda
Saint Barthélemy (Saint-Barthélemy)
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin (Saint-Martin (partie française))
Saint Pierre and Miquelon (Saint-Pierre-et-Miquelon)
Saint Vincent and the Grenadines
Samoa
San Marino
São Tomé and Príncipe (São Tomé e Príncipe)
Saudi Arabia (المملكة العربية السعودية)
Senegal (Sénégal)
Serbia (Србија)
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia (Slovensko)
Slovenia (Slovenija)
Solomon Islands
Somalia (Soomaaliya)
South Africa
South Korea (대한민국)
South Sudan (جنوب السودان)
Spain (España)
Sri Lanka (ශ්රී ලංකාව)
Sudan (السودان)
Suriname
Swaziland
Sweden (Sverige)
Switzerland (Schweiz)
Syria (سوريا)
Taiwan (台灣)
Tajikistan
Tanzania
Thailand (ไทย)
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia (تونس)
Turkey (Türkiye)
Turkmenistan
Turks and Caicos Islands
Tuvalu
U.S. Virgin Islands
Uganda
Ukraine (Україна)
United Arab Emirates (الإمارات العربية المتحدة)
United Kingdom
United States
Uruguay
Uzbekistan (Oʻzbekiston)
Vanuatu
Vatican City (Città del Vaticano)
Venezuela
Vietnam (Việt Nam)
Wallis and Futuna
Yemen (اليمن)
Zambia
Zimbabwe
We would like to connect with you on Facebook, if you would also like that, please provide the full address of your FB account, example; https://www.facebook.com/nana.berben/
Which workshops would you like to follow? (Just for indication, you can change your mind later...)
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Poi
Contact Staff
Ball Juggling
Double Staff
Staff Spinning
Fans
Dragon Staff
Dance and Movement
Yoga
Floating Wand
Would you like to borrow any Props?
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No, I' ll bring all props I need myself
Poi
Staff, for Staff Spinning
Double Staff
Juggling balls
Fans
Contact Staff
Dragon Staff
Floating Wand
Are you coming by public transport? We can pick you up at Train Station Moissac, for a fee of 10 euros
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Yes, I want to be picked up
No, I'm arranging my own transport
What is your T-Shirt Size? EU sizes. (For USA sizes, take one size bigger!)
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Please Select
XS - Female
XS - Male
S - Female
S - Male
M - Female
M - Male
L - Female
L - Male
XL - Female
XL - Male
XXL - Female
XXL - Male
Where, and from who did you hear about this retreat?
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Facebook
Instagram
Newsletter Poi Retreat
Flyer/ Poster on a festival
Juggling Calling
Google search
Aileen
Vojta
Flowbonacci
Luke
Thibault
Emergency Contact name and phone number (with country code)
Do you need to leave on Sunday the 29th of September? (you'll get 5% off your ticket if you don't stay until Monday)
Please Select
Yes, I'll leave on Sunday the 29th
No, I'll stay till Monday the 30th
Do you have any questions or things to add?
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