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Women of Color Wellness & Girls Trip Retreat Registration Form
Please complete this form in its entirety.
Email address *
Name *
Complete Mailing Address *
Phone Number (Please include area code and country code if outside of US.) *
Accommodation Choice *
Preferred Airport *
Installment Plan Choice - (Pay $300 non refundable deposit by January 1, 2019 and receive $300 off your total!) *
Requested Roommates (Please use first and last names) If you are unsure at this time, you can email when you know their names.
If you are attending the Women of Color Wellness & Girls Trip Retreat alone, please choose the statement that fits your preference.
T Shirt Size *
Dietary Restrictions *
Breakout Sessions you'd like to attend. (Please choose your Top 6 choices in order of desire. 1 - most desirable, 6 - least desirable) Note: We will do our very best to ensure you are able to participate in the sessions of your choice. *
Making Your Health a Priority - mental, nutrition, etc.
Vision & Vision Board
Balancing being a Mom/Wife, and Entrepreneur/Business Woman
Financial Wellness
Stress Management
Spirituality and Meditation
Choice 1
Choice 2
Choice 3
Choice 4
Choice 5
Choice 6
Additional Info:
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