Heart of the Healer Registration

Heart of the Healer Retreat Registration

Please fill out this form to confirm your enrollment. We are honored to join you on this journey.
Name*

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Preferred pronouns
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
example@example.com
Mobile Number*
Phone Number
Work Number
Additional Comments
Where will you be traveling from? Would you like to carpool and coordinate travel with other participants?
Please select your dietary preferences:*

VegetarianVeganGluten FreeDairy FreeOther
Please add any other dietary needs below that are not captured above:
Refund Policy

Cancellations prior to August 15th will receive a 50% refund, while cancellations between August 15th and September 12th will receive a 25% refund.Unfortunately, cancellations on September 12th or later are non-refundable.Please allow up to two weeks for refunds to be processed and completed.
Confirm your enrollment by clicking "enroll" below. Once you enroll you'll be sent an invoice which can be paid through PayPal, Zelle, or Venmo. You'll receive confirmation of your payment, and a follow up survey with questions about why you're attending and how we can best support you for our time together.
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Heart of the Healer Retreat Registration