Name *

First Name

Last Name

Gender Identity *

Male

Female

Non-Binary

Phone *

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

ACCOMODATION SELECTION *

In addition to the accommodation selected, you will be charged a $35 registration fee which is non-refundable and non-transferable.

Single: $xxxx USD

Shared: $xxxx USD

TERMS & CONDITIONS and LIABILITY WAIVER *

Please read the following document to ensure you understand and comply with the terms & conditions and liability waiver of this trip. ***INSERT LINKS HERE****

By checking this box, you confirm you have read and agree to the terms and conditions associated with this retreat

By checking this box, you confirm you have read and agree to the liability waiver associated with this retreat.

By checking this box, you confirm that you understand you are responsible for researching and obtaining travel insurance to protect your retreat investment

PAYMENT & BILLING INFORMATION *

Select the option for how you'd like to pay for this retreat. Pay in Full For this option, you will be charged the full price of the accommodation you select as well as the $35 registration fee at time of registration. Payment Plan If registering before 1/15/2025, An initial deposit ($500) + registration fee ($35) will be charged to reserve your spot. Then the remaining balance of your accommodation select will be divided over two payment on 1/15/2025 and 3/1/2025. If registering after 1/15/2025, An initial deposit ($500) + registration fee ($35) will be charged to reserve your spot. The remaining balance will be charged on 3/1/2025. If registering after 3/1/2025, The full price of accommodation + $35 registration fee will be charged at time of registration. Reminders: The $500 deposit plus $35 registration fee for this retreat are non-refundable and non-transferable regardless of the payment option selected. You are responsible for all costs associated with travel to the retreat center. This is not included in the retreat accommodation pricing.

Pay in full

Payment Plan ( 50% of balance on 1/15/2025, remaining balance on 3/1/2025)

Name on Credit Card *

First Name

Last Name

Billing Address *

Please include the billing address associated with your credit card.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Expiration Date *

Please enter the month and year of expiration. For the day, just use the 1st of that month.

MM

DD

YYYY