Sacred Space Retreat Registration Form

Sacred Space Retreat Registration Form

Register for the Sacred Space Retreat by completing all required sections below.
Participant Information
Full Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
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Email
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My Registration

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Debit or Credit Card
Credit Card Number	Security Code
Expiration Month	Expiration Year

Leadership & Retreat Goals
What is your leadership role?
What is one leadership challenge, question, or hope you would like to bring to this retreat?
Food & Accessibility
Please indicate any food sensitivities or allergies below:
Accessibility or Mobility Accommodations Needed
Emergency Contact
Emergency Contact Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Agreement / Consent
Please review the following guidelines and policy pertaining to the retreat.

Participant Guidelines
- Participate respectfully and fully.
- Treat all discussions as confidential.
Refund and Transfer Policy
No refunds will be issued for this event. In the case of a verifiable emergency that prevents attendance, participants may request a transfer of their registration fee to a future program offered by our organization. All transfer requests must be submitted in writing to Dr. Claire at contact@centerforfaithfulleadership.com and will be reviewed on a case-by-case basis. Approved transfers may be applied to a future program within 12 months of the original event date. Transfer requests must be made no later than 48 hours before the start of the event. In the event of cancellation by the organizer, participants will be offered either a full transfer to a future program or a refund, at the discretion of the organization.

Photograph/Video Release
I understand that photographs, video, and/or audio recordings may be taken during the event, and I give the Center for Faithful Leadership permission to use my image, voice, and/or likeness in connection with the event and related promotional materials without compensation.
I agree to the guidelines and policy above:
Should be Empty: