Jump Up! Registration 2019
Divorce Recovery Retreat
September 14 & 15, 2019
Montreal, Canada
Full Name *
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Where do you live? Town, state/province, country *
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Cell Phone *
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Email address *
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Age *
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How did you hear of the retreat *
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Do you plan to stay at the Omni Hotel? If so, when? (Best guess) *
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Will you join us at the Banquet Dinner on Saturday? (There is a separate charge for the dinner) *
Will you be spending the crazy fun day sightseeing with Vikki on Monday, September 16th (free of charge)? *
If you're coming with a friend or friends, who will be joining you?
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Emergency contact info (Name/cell number/email/relationship) *
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Any dietary, mobility or health concerns we should be aware of?
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Your goals (big or small) in attending this retreat in a few sentences *
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Thank you for registering for the Jump Up! You're not done yet ~ to secure your spot, please pay your fee. Do this for yourself!
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