January 2025 Grief Retreat Registration Form

January 2025 Grief Retreat Registration

This retreat is the same as the December Grief Retreat. This retreat will support and equip those in helping professions as they interact with individuals impacted by grief. It will be led by Greg Adams, Director of the Center for Good Mourning, at Arkansas Children's Hospital. Grief Retreat is January 10-12th.
Please register for the retreat below. Please note there is a 3.3% transaction fee if you pay by card for your registration.
Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Please list any dietary restrictions:

Would you like to pay by check or by credit card?
Please note that all credit card transactions incur a 3.3% card transaction fee.
Please complete the Jotform Registration process regardless of the payment option you choose. This lets us know you have registered before we receive your check in the mail.
How to pay via check:

The cost for a shared room registration is $140. Please make check payable to Mount Eagle Retreat Center. In the memo line, please include January Grief Retreat Registration. Mail check to: 935 Beal Rd, Clinton, AR 72031

Please note that in order for a credit card payment to go through, you must click Submit on the next page as well.

(The next page is the final submission to register for the Grief Retreat.)
Optional: Each attendee will be given a private room unless otherwise requested. If you would like to share a room with a specific person, please provide their name.

January 2025 Grief Retreat Registration