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Please complete and submit the following form.
Women's Retreat Registration
August 27 - 30, 2015 (Thurs, Fri, Sat, Sun)
Stone House Retreat Center
Mebane, North Carolina
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Indicates required field
Name
*
First
Last
Address
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Line 1
Line 2
City
State
Zip Code
Country
Email
*
Phone Number
*
How will you be traveling?
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Airplane
Car
Bus
Train
Will you need transportation to and from the airport or train/bus station?
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Yes
No
When do you arrive and depart? (details please)
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How many of your friends and/or family members will be in attendance?
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None
1 or 2
3 or more
Would you like to be in the same cabin with them?
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N/A
Yes
No
It doesn't matter
If "yes", please specify in the additional comments section
Your Current Age Range
*
18 - 24 years
25 - 34 years
35 - 44 years
45 - 54 years
55 + years
Date of Birth
*
Dietary Needs
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No Dietary Restrictions
Vegetarian
Vegetarian/Vegan
Are you a smoker?
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Yes
No
Do you have any allergies or restrictions?
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Yes
No
Do you have any gifts or talents that you would like to share?
*
Nothing specifically
If yes, please specify in the additional comments section
What are you most looking forward to at the retreat?
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Resting/Sleeping
Connecting with others
Emotional Release work
Writing/Reflecting
Finding balance
General Self-Care
Nothing in specific, everything in general
None of the above
Do you have any physical, mental or emotional challenges that we need to be aware of in order to better support you?
*
No
Yes
If yes, please give details in comment section
Please give us any additional information that you would like to share.
*
Submit
ABOUT
Herstory
Our Team
Our Work
SOUL
SEED
SOIL
Cross Pollinators
CONTACT US