Men's Fall Equinox Retreat 2019

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Registration Form

電子郵件 *

First Name *

Last Name *

Cell Phone *

Mailing Address *

Mailing Address 2 *

Emergency Contact Person *

Best Way to Reach Emergency Contact *

Dietary Preferences - check all that apply *

Vegan

Dairy

Eggs

Gluten Free

Poultry or Fish

Other: please describe below

Please describe any special dietary requirements or requests.

Registration - check all that apply *

Program Registration - $180 (includes food & beverages)

Indoor Shared Room - $25/night

Indoor Private Room - $50/night

Riverside Camping - Bring Own Tent - $15/night

Commuter - no additional fee

Presenter/facilitator

Scholarship contribution - any amount welcome!

Partial Scholarship Request - please contact LukeStaengl@mindspring.com

必填

Please share any other information or questions here.

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