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Dying Well Registration Form
Please fill out the following information. Space is limited to 11 persons, and the fee for this retreat is $200. Each day we will gather outside at Saint David's beginning at 9am. Our gatherings will end at 5pm.
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Email
*
Your email
Which retreat are you registering for?
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June 2 - 4
September 9 - October 1
First Name
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Your answer
Last Name
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Your answer
Street Address
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Your answer
City, State, ZIP
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Your answer
Email
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Your answer
Best phone
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Your answer
Please share any dietary restrictions or allergies you would like me to know about.
Your answer
Are you able to walk up a gently sloping trail for approximately a quarter mile?
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Yes
No
Are okay with being outside for long periods of time?
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Yes
No
I am requesting a scholarship. Scholarships are 30% of the registration fee or $140. (Suggestion: your priest may have discretionary funds to help with an additional 30% of the remainder.) Please request a scholarship if you answer YES to many of the following statements: I frequently stress about meeting basic needs and don’t always achieve them. I have debt that sometimes prohibits me from meeting my basic needs. I am working through survival credit card debt. I have no access to savings. I have no or very limited expendable income. I qualify for government assistance, including food stamps and healthcare. My family does not have access to assets; I send money to my family when able. I rent lower-end properties or have unstable housing.
Yes
Other:
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What else would you like me to know?
Your answer
A copy of your responses will be emailed to the address you provided.
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