Creating Conscious Collisions Retreat Registration

Creating Conscious Collisions Retreat Registration Form
Where: Omni Grove Park Inn – Asheville, NC
When: October 14, 2024 - October 17, 2024 (4 days – 3 nights)

Retreat Rates include the following:
- Daily Breakfast, Lunch and Dinner
- Program activities
- Cultural Tour
Optional:
- Spa services
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Mobile Number
Please enter a valid phone number.Format: (000) 000-0000.
Company Name
Professional Title
Which best describes you?
Gender
Pronouns
What do you want to attend this retreat?
Help us get to know you. Share a fun fact, hobbies, interests or anything else that will provide insights into you as a person.
What activities are of interest to you? Select all that apply.

Other
What wellness experiences are of interest to you? Please select all that apply.

Other
LinkedIn URL:
Website (if any):
Do you have any of the following dietary restrictions? Please select all that apply.

Other
Room Rates: Double occupancy is encouraged. Book double occupancy to make your stay twice as nice and share the joy with a companion while making new connections!
Single Occp: $2150
Double Occp: $1350
Which room type is your preference? Note: If you select Double Occupancy and do not have a named roommate, we will match you with another attendee.
Are you traveling with someone that will be your roommate? Note: You both must select the double occupancy rate and list each other in your application.
If so, please provide their name(s) and indicate your preference for rooming together.
Following the deposit of $350, indicate the number of payments you prefer. We will bill you for the remaining amounts to complete payment by 9/10/2024.
I understand that registration is not complete until my deposit is paid.

Complete Your Payment

Retreat Deposit

Payment of this deposit will reserve your spot. You will be billed for the remaining payments as per the schedule agreed.

$350.00

Total

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Should be Empty:

Creating Conscious Collisions Retreat Registration Form

Complete Your Payment*

Complete Your Payment