Embodied Movement Registration Form

So excited for you to join this body, heart, and soul nourishing experience! ✨Please fill out the form below and complete your payment to save your spot — we do expect the workshop to fill up quickly.

🔒 And please know: Anything you share here will be kept confidential.

Early Bird Rate: 390₪ if paid by June 30

Regular Rate: 430₪ starting July 1

IMPORTANT: Your spot is only confirmed once payment is received. If you prefer to pay in cash on the day of the retreat, please send a 70₪ deposit in advance to reserve your place.

First name*

Last name*

Email*

Phone (Use +972 before your number, and without the 0)*

City of Residence*

What do you hope to receive from the workshop?

Is there anything else that you would like me to know?

How did you hear about this workshop?

Friends

WhatsApp message

Malka Sima's Website

Malka Sima's email newsletter

Other

If a friend referred you and/or encouraged you to join, please share her name here.

Payment options:*

Israeli Credit Card – You’ll receive a secure payment link in your confirmation email.

Bit or Paybox 0526121364

Paypal - malkasimapais@gmail.com

In cash at the retreat. (Please send a 70₪ deposit.)

Bank Transfer - You'll receive bank details in your confirmation email.

Already paid

Waiver:

I understand that I am participating in a therapeutic movement class that includes instructions in physical movements, meditation, and self discovery. I recognize that this practice has inherent risks that include bodily injury and I understand that this class is not a substitute for medical or psychotherapeutic treatment. I hearby accept and take full responsibility for any and all risks associated with participation in this class.

I would like to hear about more opportunities for healing and transformation. Please subscribe me to your newsletter.