2025 – Retreat Registration

*** PLEASE READ ***

Please fill out the information below and send it over. We will reach out to you for the next steps and to take payment. Sleeping Arrangements are in groups of 2 to a room. If you have a person in mind to share (or to not to) with please note that in the additional comments section. All information is held in the STRICKEST CONFIDENCE. Nothing shared or sold!

If you like, use this QR Code to pay for registration online. Just scan with phone camera app fill out the information.

Hosted at Fields Cabin @ cleftRock Retreat Center in Mt. Vernon. Maps Link

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Name *

First

Last

Mailing Address *

Email *

Email

Confirm Email

Days Planning To Attend *

• March 28th
• March 29th
• March 30th

Any Allergies or Food Restrictions? *

Notify Me Of Future Conferences/Events?

• YES! Please

Me Address Future

Comments or Questions

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