EmpowerHER Registration Form

First name

Last name

Email

Phone

Room Choice

Shared Room $2100.00 per person

Private Room $2700.00

Villa Shared $2700.00 per person

Villa Private $3900.00

Add your text

By checking the consent box and signing below, you confirm that you have read and agree to the Retreat Waiver Agreement.

Consent and Waiver Agreement and Signature

Signature

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Retreat Payment

$

Since the retreat is now within 60 days of the start date, full payment is required upon registration.