Women's Retreat Registration and Deposit Form

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

YesNo, already have a roommateNo, selected single occupancy

YesNoN/A

Roommate's Name*

*Entering a name indicates that the individual has agreed to be your roommate. Enter N/A if not applicable.

Resort Room Selection*

Single Room Payment Plan

This is the deposit or installment for the single occupant room. The total cost for the 4 days/3 nights at Kingsmill Retreat is $882 (including T-shirt). $50 deposit, total of $832 remaining, paid over 6 installments of $139.00.

$50.00 Deposit (1st)/Installment Payments (2nd - 7th)

Double Occupancy Payment Plan

This is the deposit or installment for the double-occupant room. The total cost for the 4 days/3 nights at Kingsmill Retreat is $456/ea (including T-shirt). $50 deposit, total of $406 remaining, paid over 6 installments of $68.

$50.00 Deposit (1st)/Installment Payments (2nd - 7th)

Subtotal

$0.00

Tax

$0.00

Total

$0.00

Payment Methods (a 3.5% credit card/e-fund fee is included in payment)

Credit Card

Apple Pay

Google Pay

Cash App Pay

ACH Bank Transfer

WOMEN'S RETREAT 2026

Payment Methods (a 3.5% credit card/e-fund fee is included in payment)