Black Obsidian Retreat Registration & Wellness Commitment Form

Our all inclusive retreat will be a spacious gathering. We facilitate a brief session each day, and the rest of the time is yours to use in a way that makes sense for you. You might use the time to go for a walk, or take a nap. You may want to gather some folks to chat about a book or have a ping pong tournament. We will provide resources for self directed small group practices like deep listening or the Clearness Process that is designed to help you think through challenges using the wisdom of questions. There will also be one on one coaching sessions as well as body work that will be available from our facilitators. Lodging meals and all activities are included in the one time fee. If this is for you, please fill out the form below and click the link to submit your payment.

Please note: This retreat is for people with Black bodies and identify as men.

Thank you for committing to your wellness good brother.

Full Name

First NameLast Name

Date of Birth

MonthDayYear

Email Address

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You like to be included on our email list to hear about upcoming activities.

Phone Number

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

Mailing Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Emergency Contact Name

Emergency Contact Phone Number

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

Do you have any dietary restrictions? If so please list them.

Please list any allergies or medical conditions we should be aware of.

How did you hear about our retreat?

Why is now the right time for you to be on this retreat?

What do you hope to get out of this retreat?

Anything else you'd like us to know?

Do you identify as Black

Are you a masculine identified person?

Part of building belonging is maintaining a space that supports presence and connection. To do that we ask that you keep phone and laptop use to a minimum and that you plan to be in attendance for the full retreat. Can you make that commitment to your wellness?

Please indicate which fee you will be opting into.

Please use this payment link to the submit the fee option you selected.