2023 Honoring Touch (TM) Retreat Application

2023 Honoring Touch™ Retreat

April 14-16 2023, Cook Forest, Pennsylvania
Guest Information

This application is for screening for eligibility purposes. Emergency contact and other relevant information will be obtained in a separate form with your original signature once you have been approved for participation in the retreat.
Name*

First NameLast Name
Email (Please double check spelling)*
example@example.com
Phone Number*

Area CodePhone Number
Alternative Number

Area CodePhone Number
Select which state you are a resident of: (If you are a resident of any of the following 5 states you are not eligible to participate in this retreat due to legal and tax purposes)*

CaliforniaWashington StateIdahoFloridaHawaiiOther. You are still eligible. Please proceed with application.
Additional Participants
Will you be bringing someone with you?*
Do you plan on sharing a bed with them?*
Has this person already completed an application *
If you're bringing someone, you will need to identify one another on these forms. Please type their name here, or type N/A if this doesn't apply: blanks*
PLEASE NOTE: In order to receive the discount for attending with another participant all parties have to complete individual applications, submit documents individually and be approved for the retreat. Please note the sooner that you both complete the applications, we can then proceed with processing your application and payment to reserve your spot in the retreat. Both parties need to name and identify the other party on their application.
Things We Have to Ask...
Are you over the age of 18? (Participants under the age of 18 legally cannot participate in this retreat)*

Yes, I certify that I am age 18 or older. Please Continue.No. Please Discontinue Registration - sorry you are not eligible.
Are you a registered sex offender in any state or country?*

No. Please Continue with Completing Application.Yes. Please Discontinue Registration - sorry you are not eligible.
Additional Information

Please provide detailed answers so we can best accommodate your cabin preferences and content needs. We can't promise perfection, but we'll do our best!
What type of sleeper are you? (we ask in an attempt to avoid putting opposites in the same room, but cannot guarantee that this will be accommodated)

Night OwlEarly RiserIndifferent
How did you learn about the 2023 Honoring Touch (TM) Retreat? *
With all the other retreat opportunities out there, why choose this retreat? *
What do you hope to accomplish or get out of your experience during the 2023 Honoring Touch(TM) Retreat?*
What questions or concerns do you have about the retreat, what to expect, etc?*
Any additional information you would like to share, add or clarify?
Confirmation & Consent. BY SUBMITTING THIS APPLICATION ELECTRONICALLY I AM CONFIRMING AND ACKNOWLEDGING THAT ALL INFORMATION PROVIDED IS ACCURATE AND TRUE TO MY KNOWLEDGE.

I PROVIDE CONSENT FOR THIS INFORMATION TO BE COLLECTED AND STORED ELECTRONICALLY AND TO BE USED FOR PURPOSES OF DETERMINING MY ELIGIBILITY FOR THE 2023 HONORING TOUCH(TM) RETREAT AS WELL AS FOR PLANNING AND COORDINATION. I AGREE TO BE CONTACTED BY PHONE OR EMAIL UPON SUBMISSION OF APPLICATION.

I UNDERSTAND THAT SUBMITTING THIS APPLICATION DOES NOT GUARANTEE MY PARTICIPATION IN OR APPROVAL FOR REGISTRATION FOR THE 2023 HONORING TOUCH(TM) RETREAT AND THAT ALL APPLICANTS HAVE TO BE SCREENED AND APPROVED.
Next Steps - ONCE YOUR APPLICATION IS SUBMITTED YOU SHOULD HEAR BACK FROM US WITHIN 5 BUSINESS DAYS. IF YOU DO NOT HEAR FROM US, PLEASE CONTACT US AT EMBODYHEALING@GMAIL.COM WITH "HONORING TOUCH RETREAT" IN THE SUBJECT.
Signature*

Clear
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2023 Honoring Touch™ Retreat

Guest Information

Additional Participants

Things We Have to Ask...

Additional Information