PART Participant Assignment Status*

Please let us know if you can attend the retreat.

Contact Info

First Name

Last Name

Mailing Address

Mailing Address Line 2

City

State/Province

Postal Code

Country

Email Address

Yes, I would like to receive email communications.Yes, I would like to receive email communications.

Accepted Status

Declined Status Reason

Accepted Status

Other Reason

Retreat Attendance

The Next Section Only Applies if You Choose to Attend a Retreat

Before You Are Considered Further For This Retreat, We Ask That You Confirm the Following:You can attend the retreat on these dates for the entire week.You are responsible for the travel to, during and from the retreat.You must have your medical professional complete and return the medical verification form included in the email by the date given.

What Are You Looking Forward To?

Signature Affirmation

By entering your First & Last name you verify the information on this form has been entered to the best of your ability

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