Wine-Down Wellness Retreat Registration and Sponsorship (December 2024)

FULL NAME (Each attendee must be pre-registered)*

First NameLast Name

FULL ADDRESS*

EMAIL ADDRESS*

PHONE NUMBER*

AGE CONFIRMATION (Check YES or NO to confirm I am at least 21 years old to participate in the Wine & Wellness Sip Reception*

YESNO

WEBSITE (Provide only if you will be a sponsor)

NAME OR BUSINESS LISTING FOR PATRON OR SPONSOR

REGISTRATION TYPE, PATRON OR SPONSORSHIP LEVEL

Individual Registration $129.00 (on or after December 1st)$250-Breakfast Sponsor (up to 4)$500.00-Lunch Sponsor (up to 5)$500.00-Wine & Wellness Sip Reception Sponsor (up to 5)$50.00-Beginning Journey Patron (not attending but supporting the event/does not include registration)$100.00-Healing Patron (not attending but supporting the event/does not include registration)

DO YOU HAVE ANY SPECIAL DIETARY NEEDS, MEDICAL CONDITIONS OR ALLERGIES THAT THE ORGANIZER SHOULD BE AWARE?(If yes, please list name and issue below)

YesNo

LIST SPECIAL DIETARY NEEDS, ALLERGIES OR MEDICAL ISSUES - IF NO, PLEASE TYPE "NONE" (Organizer will try to accommodate any special needs, if possible within the confines of the hotel and catering services.

I agree to the terms and conditions set forth by Our Wellbeing, LLC (EIN 93-2093692). Our Wellbeing, LLC reserves the right to refuse any registrations, patrons or sponsorships if it is deemed inappropriate, offensive, or not in line with the company’s goals and objectives. I certify that I understand that all registrations, patrons or sponsorship fees are final and there are no refunds. However, if I register and cannot atten, I may receive a credit towards a future Our Wellbeing, LLC event. I will contact the organizer prior to the event for further information.

Furthermore, I have read the sponsorship materials and understand that my sponsorship is not a tax-deductible contribution, and there is no entitlement or guarantee for receiving or business development relationships, contracts, agreements, etc. from my sponsorship. I also understand that by signing this form that it is legally binding.

I agree to indemnify and hold harmless OurWellbeing, LLC for any injuries, damages or losses that I incur and waive my rights to claim or sue Our Wellbeing, LLC for injuries, damages or losses incurred. If I am a sponsor, I will also provide proof of my own liability insurance for this event upon request.

Please print your full name and title then sign the form below. Thank you for your support!

Please verify that you are human*

Registration, Patron or Sponsorship Amount*

USDDescription

Signature

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Wine-Down Wellness Retreat: Resetting Your Mind for 2025