Registration Form

Full Name *as shown on ID

Name your prefer to be called (nametag)

Email *

Phone with Country Code *

Address

Mailing Address

City

State

Country

Postal Code

Emergency Contact

Emergency Contact Phone Number

Accommodation Selection

See Registration Page for full descriptions and payment details.

Some options have limited availability and are allocated on a first come, first served basis.

Please indicate every option you would be willing to reserve, ranked by preference. We will do our best to accommodate your first choice

when possible. Selections acknowledge your reservation agreement. Early Bird Registration requires payment in full by August 15, 2026.
Full Price Registration requires payment in full by October 15, 2025.

For all options, a $400 non-refundable deposit is due with registration.

First Preference - Early Bird price listed ($500 discount)

Double Occupancy - $2,595

Single Occupancy - $2,795

Suite (shared bed) - $2,895

Second Preference - Early Bird price listed ($500 discount) (copy)

Double Occupancy - $2,595

Single Occupancy - $2,795

Suite (shared bed) - $2,895

Additional Considerations

Do you require ground Floor/disability considerations? (limited rooms available)

Yes

Provide Specifics

Do you know who you would like to room with?(If no, a roommate will be assigned)

Yes

Preferred Roommate Name

What is your sex? (for purposes of room assignments)

Female

Male

Do you snore?

Loud

Soft

Unknown

Medical & Health

List medications:

Provide details of other medical, health, disability/mobility concerns. Include requests for support for above conditions and medications (ex. refrigeration of medication)

Dietary Requirements

Provide additional details on allergies and dietary requirements

Transportation

How do you plan to travel to the retreat? (Note: Request for Travel Details Form will be sent later)

Fly

Drive

Agreement & Consent

By checking this box, I acknowledge and consent to the information in this form being shared with the facilitators (Jayem and Kendra) and retreat organizer (Leah). Beyond that it will be held in strict confidence.

By checking this box, I agree to comply with all venue, retreat
organization and payment requirements. I agree to read the Participant Welcome Packet that will arrive via email from [email protected].

I understand that registration is not complete until a $400 non-refundable deposit or full payment has been made.

Please check all folders and add this email address to your Contacts to ensure deliverability.

Click here to be directed to Payment Portal.