1. Ireland Retreat Registration Form

🕊️ IRELAND SELF-MOTHERING RETREAT – REGISTRATION FORM
Join Dr. Gertrude Lyons in Kerry, Ireland – October 3 - 9, 2026. A week of deep rest, reflection, and renewal on the wild west coast of Ireland. This gathering invites you to reconnect with your inner wisdom, awaken self-love, and return home more grounded, open, and free.
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
E-mail*
example@example.com
Tell me a little bit about yourself*
Why are you drawn to a Self-Mothering experience?*
In what ways does the idea of being cared for in the company of other women appeal to you?
How did you hear about us?

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Anything you want to add?
Payment Schedule:

Total Cost of Retreat: $5,527

- 50% Payment due by May 1, 2026
- Final Balance due by June 1, 2026

If you would like to set up a custom payment plan, we are happy to accommodate — simply reach out to us directly.

Refund & Cancellation Policy:

- All deposits are non-refundable.
- Cancellations made on or before May 1, 2026 will receive a 50% refund of all payments made, excluding the deposit.
- Cancellations made after June 1, 2026 are non-refundable, as accommodations and services are pre-booked.
In the unlikely event the retreat is canceled by the organizer, all payments will be refunded in full.
Agreements & Acknowledgements
I understand that this retreat is a personal development experience, not a replacement for therapy or medical care.

I acknowledge that I am responsible for travel arrangements, insurance, and personal belongings.

I understand the payment schedule and refund policy.
Signature*
Date

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Please confirm your understanding*

I have read and agree to the statements above.

My Products*

Deposit - Immersive Experience/Gathering $444.00

Total $0.00

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🕊️ IRELAND SELF-MOTHERING RETREAT – REGISTRATION FORM

Agreements & Acknowledgements

Credit Card