Retreat Registration We are so thrilled to have you join us! Please complete the form below to complete your registration. There will be a pre-retreat group zoom meeting on Wednesday April 30th from 6-7pm. Please add this date to your calendar. Personal Information Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Phone * (###) ### #### Date of Birth * MM DD YYYY Current Age * Emergency Contact Name and Relationship to You * Emergency Contact Phone Number * (###) ### #### Registration Information Co-Registrants If you are registering with a friend, spouse, or family member, please provide their name for room assignments and indicate if you prefer 2x single beds or a king sized bed. Dietary Requirments Do you have food allergies or specific dietary requirements? If so, please provide details below. Payment Information You can choose 1 payment (today) or 4 payments (on dates you choose). Retreat fees MUST be paid in full by May 1, 2025. We prefer e-transfer payments. Credit cards will only be processed in an event that your payment is not received via e-transfer on the date specified. Credit cards payments are subject to a 3.5% processing charge. Email your payments to rtcstrathmore@gmail.com after you submit your registration form. If you require special receipting to submit to insurance, please email rtcstrathmore@gmail.com to let us know. Note that receipts for insurance can only be provided after the retreat date. Which payment option do you choose? * 1 Payment of $1295+GST (Today) 4 Payments of $333+GST (Dates specified below) Instalment Dates (if applicable) One payment is due today. Please provide the 3 dates you wish to make payments. You will receive an email reminder to e-transfer your instalment. Instalments not received on the instalment date indicated will be charged to the credit card on file with a 3.5% processing charge added. Must be paid in full by May 1, 2025. Leave blank if you are paying in full today. Credit Card Number * Will only be charged if instalments or payments are not received via e-transfer. A 3.5% processing fee applies. Name on Card * Credit Card CCV * Credit Card Expiry Date * Miscellaneous Pre and Post Measures * In order to assess the effectiveness of our services, we may ask you to complete 1-3 short forms regarding your adjustment, before and after the retreat. This is optional, but helps us improve for future offerings, and also helps us secure funding from government ministries to provide services to those less fortunate. Yes No Is there anything else we should be aware of? Refund Policy * I understand the refund policy is that retreat fees are transferable only. Thank you for your registration! We can’t wait to work with you in the beautiful Rocky Mountains of Golden, BC.Please e-transfer your payment to rtcstrathmore@gmail.com to complete your registration. Indicate your full name in the memo section.Total amount for 1 payment with GST is $1359.75.If you choose instalment payments,the payment for each of the 4 instalments with GST is $349.65. One instalment must be received at the time of your registration.After your payment is received, you will receive a packing list and welcome package within 3 business days. A liability waiver will require completion closer to the retreat date.Please add Wednesday April 30th at 6pm to your calendar for our pre-retreat zoom meeting. You will receive a zoom link together with your pack list and liability waiver.
