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 womenofcolorwellness@gmail.com 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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