Conscious Grieving Retreat Registration (Summer 2026)

Conscious Grieving Retreat Registration

To ensure the best experience possible at the retreat, we would love to know a little more about you. Once this form is submitted, you will receive a welcome email with payment instructions within approximately 3 business days. In the meantime, please be sure to carefully read the retreat website, as you can find many answers to your questions there. Payment of the balance (or beginning a payment plan) is due within 30 days of receiving your welcome email (or by July 9). See website for cancellation policy. Space is limited: registration ends June 30 or when spots are filled.
Thursday, July 30 – Sunday, August 2, 2026

Ralston White Retreat, Mill Valley, CA
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact
Name and Phone
Medical Conditions/Allergies
Dietary Restrictions
We will have vegetarian, gluten free, and dairy free options available.
Age Range
Gender
This information helps us with shared room planning and retreat logistics.
Briefly share a little about yourself and your loss.

0/350
Why are you registering for the retreat?

0/350
What do you hope to get out of the retreat?

0/350
Any Questions/Concerns about the retreat?

0/350
Anything else you would like us to know?

0/350
Please let us know if you are traveling with friends/family and have roommate requests.

0/350
How did you learn about this retreat?
Rooming and Day Guest Options
PRIVATE ROOMS ARE FULL. PLEASE CHOOSE SHARED OR DAY GUEST OPTION AND LET US KNOW IF YOU WOULD LIKE TO BE PLACED ON THE WAITLIST FOR A PRIVATE ROOM. Note: bathroom and shower facilities are shared on each floor regardless of room type. Please see retreat website for more information.

Conscious Grieving Retreat Deposit

Non-refundable Conscious Grieving Retreat Deposit goes toward your full retreat cost. An email with further information and payment instructions will be sent within 3 business days. Payment plans for the remaining balance are available through the popular buy now, pay later methods Klarna, Affirm, and/or Afterpay. Options will be available at checkout. Note that payment plan offerings vary based on region and purchase history.

$200.00

Total

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

Conscious Grieving Retreat Registration

Thursday, July 30 – Sunday, August 2, 2026

*