Registration for Feb 15-17, 2019 Courage to Teach Retreat
Complete this form to register for the February 15-17 2019 Courage to Teach Retreat at the Santa Sabina Center in San Rafael, Ca.

Dates of the Retreat: Feb 15-17, 2019

As part of this registration process, please write a Personal Statement (not more than two pages) to help us get to know you before the retreat. You will be asked to upload your writing in the last question of this form. So it is best to write the statement prior to completing this form.

In your personal statement, please include:

• How you learned about this retreat series.

• Why you are interested in participating, and how you hope to benefit personally and/or
professionally.

• The setting in which you currently do your work.

• A question you are currently holding about your life or vocation.

After you complete this form, we ask that you make your retreat payment today on New Leaf Collaborative website.

First and Last Name *
Mailing address *
Email *
Phone Number *
Have you participated in a Courage to Teach retreat before? *
What is your primary role as an educator? *
Required
Special Dietary Needs (if any):
Please upload your Personal Statement. *
Required
Cancellation Policy: 1. You will be billed for 50% of the total room and meal fees when cancellation is received 15 days prior to the retreat date. 2. If cancellation is received 7 days prior to the retreat date, you will be billed for 75% of total room and meals. 3. If cancellation is received less than 7 days prior to the retreat date, you will be billed for 100% of the retreat cost. *
Have you made your PayPal payment yet? *
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