Name *

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Retreat Week(s) Attending. *

Which week or weeks will you be joining us?

Week One - January 3rd - 10th ( New Years Week)

Week Two - January 10th - 17th (Women's Alumni & Guest Week)

Both Weeks (Please choose a room type below for each week)

Are you planning on sharing a room with someone? *

Yes

No

Financial Responsibility. *

Will you be covering the cost just for yourself, or also for the person you’re sharing a room with?

I plan on sharing a room and I'm covering the cost of both parties.

I plan on sharing a room, but I'm covering my own cost.

I'm not sharing a room and I'm covering my own cost.