January 2024 Circle of Trust Registration Form

January 2024 Circle of Trust Registration

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

One 3-Day in-person gathering: Thursday, 5PM - Saturday, 2PM;
- January 18-20, 2024
Name*

First NameLast Name
Prefer to be called
Email*
example@example.com
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 dietary/logistical and accessibility needs*
Is this your first Circle of Trust?*

YesNo
The facilitator team will be in touch to welcome you and cover any questions you may have. Please feel free to reach out to info@wholeheartinc.org to request a call at your convenience.
How did you hear about this offering?*

WholeHeart EmailSocial MediaPersonal InviteOther

My Products

Full PaymentOvernight Double Occupancy: $575 // Overnight Single Occupancy: $675 // Day Rate: $375

$575.00 Overnight/Day Guest Choice

Payment PlanInitial deposit of $150 reserves your spot. Remaining balance to be paid via invoicing prior to the event.

$150.00 Quantity

Complete Your Payment PlanIf you have previously made a deposit, you can complete your payment plan by selecting a choice below.

$425.00 QuantityOvernight/Day Guest Choice

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.