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.
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.*

Self-Care & Wellness: Spa, Relaxation and RejuvenationHiking/walkingHistorical/cultural tourNo preferenceOther
What wellness experiences are of interest to you? Please select all that apply.*

Meditation/MindfulnessSpa MassageSpa FacialYogaNo preferenceOther
LinkedIn URL:*
Website (if any):
Do you have any of the following dietary restrictions? Please select all that apply.*

NoneVegeterianVeganPescatarianGluten-FreeKosherNut FreeOther
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.

Singe occupancy - $2150Double occupancy - $1350I’m okay with either.
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.

YesNo
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.*

123
I understand that registration is not complete until my deposit is paid.*

Yes, I understand.

Complete Your Payment*

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

$350.00

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Should be Empty:

Creating Conscious Collisions Retreat Registration Form