April 2023 Circle of Trust Registration Form

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April 2023 Circle of Trust Registration Form

Please note you can save your registration and return to later.
Dates (all times in EST):

One 3-Day in-person gathering: Thursday, 5PM - Saturday, 2PM;
- April 13-15, 2023
Name*

First NameLast Name
Prefer to be called
Email*
Phone Number*

Area CodePhone Number
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What draws you to participate in this Circle of Trust?*
What life questions are you holding at this time in your life?*
Please indicate any requests for accommodations or needs (meals/room/ accessibility):
Is this your first Circle of Trust?*

YesNo
New participants will be contacted to cover any questions you may have as welcome.
How did you hear about this?*

WholeHeart EmailSocial MediaPersonal InviteOther

Payment
The full cost of participation is $550 for overnight guests and $350 for daytime guests - to be paid in full prior to the event. You may pay in full now, or reserve your spot for $150 and be invoiced for the remaining balance.

Scholarships are available. Please contact Nate for details. (nate@wholeheartinc.org)

Payment selection: (select one option)

Full Payment$550.00

Overnight: $550 Day rate: $350

Overnight/Day Guest Choice

Payment Plan $150.00

($150 now and remaining balance paid via invoice prior to event start)

Enter coupon

Total $0.00

Payment Methods

Debit or Credit Card

First Name

Last Name

Credit Card Number

Security Code

Card Expiration

Please click one of the PayPal options to complete payment and submit the form.