January 2025 Circle of Trust Registration Form

Living with Courage: 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 17-19th, 2025
Name*

First NameLast Name
Prefer to be called
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
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: $475

$575.00 Overnight/Day Guest Choice

Payment PlanInitial deposit of $200 reserves your spot. Remaining balance to be paid via invoicing prior to the event.

$200.00

Enter coupon

Total

$0.00

Payment Methods

Debit or Credit Card

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

Living with Courage: Circle of Trust Registration