Individual Registration

Please enter information in the form below to process registration for event 45th Annual Woman to Woman Fall Retreat .

First Name *

Last Name *

Email *

Phone *

Sobriety Date *

Address *

Address 2

City *

Zip *

Country *

State

Emergency Contact Name & Phone *

Lodging Options *

Commuter: $225.00 includes all meals, but NO LODGING

Single: $425.00 includes all meals and lodging

Double: $360.00 includes all meals and lodging

Triple: $305.00 includes all meals and lodging

I am willing to be of service? *

Yes

If selecting Double or Triple rooms options, tell us who you would like to room with here.

I would like to Donate to the Scholarship fund.

$5.00

$10.00

$20.00

$25.00

$50.00

$100.00

Amount

Payment Method

Send Payment by Zelle: womantowomanfallretreat@gmail.com