RAW Impact

i4 Live Retreat, 2017 Cambodia
Program Registration

Thanks for your interest in our i4 Live Retreat Program. Once you complete this registration form you will be redirected to a payment page.

About the Retreat

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Program Details

The i4 Live Retreat Program will be held in Cambodia in partnership with non-for-profit organisation RAW Impact in October 2017 from Sunday 15th to Saturday 21st. To read more click here.

We look forward to sharing this adventure with you!

The About my Brain Team

Completing your Enrollment

Ensure you have reviewed the trip information contained in the Program Guide before enrolling. You will be able to explore all the details that we need by scrolling through this page.

In order to submit this form, the details marked with a 'red asterisk' must be filled out. Not all the fields are compulsory on registration if you don't have all the details. Closer to the trip date, we'll be in contact to ask for the remaining information.

If you have any queries about your enrollment, please contact us and we'll do our best to get back to you within 48 hours.

Payment Options

Once you have submitted this form, there are 2 payment options to choose from:

  • The first option is to pay the $4,950 AUD in full and receive an early bird discount of 10% for bookings made before May 23rd, 2017.
  • The second option involves paying a $1,200 AUD deposit and the balance of $3,750 AUD before June 23rd, 2017.

All payments can be made by Credit Card, PayPal or Bank Transfer. If you elect to pay by Bank Transfer, please ensure you organise payment within 48 hours of completing this form to secure your spot.

In addition, we ask that you quote the invoice number and send us a receipt so we can track your payment.


If you have been given a discount code, you will be able to enter this code on checkout. In regards to the early bird discount, all full payment bookings made prior to May 23rd, 2017 will automatically have a 10% discount applied on checkout.

Confirmation & Communications

You should receive an invoice / receipt and a confirmation of your registration to your nominated email address.

We will also be sending communications about logistics closer to the date, so keep an eye out in your inbox!

Participant Details

Enter your information below. If you are booking on behalf of someone else, please fill in the details of the person who will be attending the retreat program. Each registration must be completed separately.


Date of Birth
Please note that you must be 18 years and over to attend this retreat.




Emergency Contact

Tell us a little about you

Share with us why you want to come on this retreat and if you have any specific skills or experience that can help the RAW Impact team in Cambodia.

Passport, Expiry Date & VISA

Ensure your passport is up to date with at least two blank pages for visas and at least six months validity beyond your intended return date. You will also need to carry two passport-size photos and $30 USD cash for the visa application on arrival.

We recommend you obtain your visa before departure, which can be helpful to avoid possible lengthy delays. VISA applications can be made online here.

Insurance & Flight Details

The following details are not required if you haven't organised flights or insurance yet, however, we will ask for this information closer to the departure date:


The program will officially start at 11am on Sunday 15th of October 2017. We recommend you arrive in Phnom Penh anytime on Saturday 14th so you can rest and prepare for the start of your adventure!

If you plan to fly in on Sunday, aim to arrive in the early morning so you can make it on time for the start of the retreat, which will take place at the Plantation Urban Hotel. Please arrange your own transfer to the hotel based on your arrival time.


We recommend you to book your return flight after 7:30pm on Saturday 21st if you wish to travel back from Kep to Phnom Penh in our group transfer. Alternatively, if you require an earlier departure, we can arrange a separate taxi service to the airport.


Need help booking a flight?
Simply follow this link to search for affordable flights to Cambodia.

Accommodation Options

Would you like single accommodation?
The retreat includes 6 nights of twin share accommodation starting from Sunday 15th and checking out on Saturday 21st of October, 2017. If you would like to have your own room, click 'yes' below. Please note that a non-refundable fee of $495 USD will be invoiced separately and must be paid within 48 hours of receiving the invoice.


Traveling with someone?
If you are attending with a spouse, partner or friend and would like to stay in the same room, select 'yes' and provide his/her name:


What is your partner's name?
Please note they must also register separately.


Do you need an additional night of stay?
If you are planning to arrive on Saturday 14th and would like to book an additional night at the Plantation Urban Resort simply visit their website to book your room. Alternatively, you can stay at a hotel of your choice.

Dietary Requirements

Let us know if you have any specific dietary requirements so we can plan our catering to suit your needs. We aim for all our food to be fresh and brain friendly.

Allergies or Relevant Medical Conditions

If for medical reasons you are unable to participate in the house building project, do not worry! This retreat caters for all physical levels and abilities and there are plenty of tasks that you can do to support the team. Remember that this is a tropical country; if you have health concerns, consult with your doctor prior to registering.

Background Check

As per the Terms in our Program Guide , you must provide a recent photo no more than one year old:



Please provide a National Police Certificate, Background Check OR Working with Children Check. If you don't have access to this yet, you can still enrol, however, this document must be provided before the departure date. We will send out a reminder. For Australian residents, you can obtain your 'Working with Children Check' here.


Billing Details

Complete the billing details you would like to appear on your invoice / receipt. Please note, if you an Australian Resident or Company, a 10% Tax (GST) is applicable to all purchases and will be added to the total amount on checkout.


Billing Address

A few last bits!

Thank you for providing this additional information!

How did you initially hear about our retreat?


If you have been referred by a certified i4 Practitioner, please let us know by selecting 'yes' and providing his/her name:

What's the i4 Practitioner's name?

Further Questions

Do you have any other questions in regards to the program?


This program is non-refundable. If you are unable to attend, the enrollment can be transferred to someone else or the credit can be used towards any future programs run by the About my Brain Institute.

By clicking the box below and submitting your registration, you are agreeing to the Terms & Conditions outlined in our Program Guide .


Ready to enrol?
Before submitting, please ensure you have reviewed all the details in this form. We will send you a confirmation email with your enrollment information for future reference.

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