Name *

First Name

Last Name

Phone *

(###)

###

####

Retreat Week(s) Attending *

What week(s) are you planning on attending the retreat? If you have any specific room preferences, kindly let us know by listing them. Otherwise, please note that the rooms are allocated on a first-come, first-served basis, limited spaces available.

Week One - January 3rd - 10th (Open to All).

Week Two - January 10th - 17th Alumni & Guest Week (Open to all who identify as women).

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

Are you planning on sharing a room with someone? *

Yes

No

Financial Responsibility *

Are you financially responsible for just yourself or are you paying for someone else?

I plan on sharing a room and I'm financially responsible for both parties.

I plan on sharing a room and I'm financially responsible for myself.

I do not plan on sharing a room and I'm financially responsible for myself.