Registration Form for Women's Sacred Wisdom Retreat in Peru
 

Name *
Name
Address
Address
Phone
Phone
Emergency Contact
Name
Name
Phone
Phone
Food Requests/Allergies
I have food allergies.
Accommodations
Choose your room type *
If you are traveling with someone, please select "Double" and write the person's name in the box below. If you are not traveling with anyone you know and would like to share a room, please check "find me a roommate" in the box above.
Payment
A non-refundable deposit of $500 is required for registration. Deadline for registration is June 1, 2018. Final payment due July 1, 2018. If you choose to only pay the deposit at this time, we will contact you the week of July 1, 2018, to authorize payment for the remaining balance.
A 3% service fee will be applied to all credit card transactions.
Please make out all checks to Elm City Wellness and deliver them to: Elm City Wellness 774 Orange St. New Haven, CT 06511
I have read and agree to the Terms & Conditions *
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