Retreat Application

Retreat Application

Retreat*

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First Name*

Last Name*

Buy It Now or Bids*

Minimum bid $550 BIDDING IS NOT AVAILABLE FOR ON-LINE WORKSHOPS

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Coupon Code

Only if requirements met. Multiple codes cannot be used.

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Referred by

If attending with someone, please provide name

Payment

Credit Card Number (We do not currently accept AmEx)*

Expiration Date*

Name as It Appears on Card*

Billing Address*

Contact Information

Please note that we do not use or sell this information. It is required only so we have a way to contact you if needed about the workshop.

Telephone Number*

Please enter in format xxx-xxx-xxxx (with hyphens)

Email Address*

Birth Details

Birth Date*

Birth Time

please indicate if exact or estimated

Birth Place*

Agreements

By clicking here you acknowledge that you are making a binding commitment to a space at the retreat and that you understand that your card will be charged prior to the retreat if and when you get a space.Your spot in the workshop is not guaranteed until payment has been received.

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I am aware that my payment is non-refundable, though it may under certain circumstances be transferable to the next scheduled retreat or workshop, minus an administrative fee of at least 10%.

Payment Agreement*

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