Program Information

You are registering for:

Program:: Liberation Online Retreat
Dates:: July 1-4

Registrant Information

* First Name:
* Last Name:
Alternate Name:

* Gender:

Female
Male
Non-Binary

* Street Line 1:
Street Line 2:
* City:
* State/Province:
* Zip/Postal Code:
Country: Defaults to USA
* Telephone:
* Email:
* Email Again: Repeated to be sure it is right

Donation

Dear Friends,

This retreat is offered on a sliding scale for a minimum donation of $50. Please give what you can. Your generosity and support are both needed and greatly appreciated.

$50
$100
$250
Other:

Preferences

How did you first hear about this program?

HFS Email/Newsletter
MMC Program Brochure
Flyer or Postcard
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Shall we keep you informed of events at Mount Madonna Center?

Yes, send me occasional e-mail announcements.
Yes, send me postcards and brochures in the mail.
You may share my address with MMC affiliates.

Please contact me regarding massage or other bodywork during my stay.

Would you like to contribute to our Green Fund?
Amount

Green Funds will be used for sustainable innovations and eco-events at MMC.

Important Notes

Cancellations made at least 2 weeks before your reservation date are fully refundable. Cancellations made 2 weeks to 48 hours prior to arrival date will be charged a $50 processing fee and the remaining payment will be held as a credit toward a future personal retreat or program. There are no refunds for cancellations made less than 48 hours prior to your reservation date.

Registration - Step 1

Program Information

Registrant Information

Donation

Preferences

Additional Requests

Important Notes