EIR Retreat Reg Form

EIR Retreat Registration & Payment

February 8-12, 2024, San Diego CA
Name:

First NameLast Name
Birth Date

MonthDayYear
Date
E-mail
Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
How did you hear about this event?
What other sexuality experiences or workshops have you attended?
What is it about this weekend that intrigues you to participate? In other words, what do you hope to experience?
Write a few sentences about yourself...
Do you have any food constraints?
Anything else you like to say?
Carpooling?

Two Person Room$1,390.00

Dorm Room$1,190.00

(optional) Add to the Scholarship fund$20.00

Add as many "$20 bills" to the scholarship fund by increasing the quantity below - thank you for your generosity!

Quantity

Total $0.00

EIR Retreat Registration & Payment