Registration - Rewiring Together

Rewiring Together

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Registration

Registration Form
Embodying the Queen

* Indicates required field

Basic Info

Name *

First

Last

Phone Number *

Email *

City and State *

Date of Course *

March 14-16, 2025 April 4-6, 2025 May 16-14 (private program) September 12-14 October 3-5, 2025

How did you hear of this workshop? *

Personal Development & Questions?

Please specify any personal development work you have done, and any other concerns or questions. *

Travel for the Shenandoah Workshops

Workshop is 90 minutes due west from Washington D.C., and 75 minutes from Dulles Airport *

I will drive myself to the course I am willing to carpool Flying into Dulles Airport and like a ride Still to be determined

Additional travel information or requests *

Dietary Restrictions

Please note we may not be able to accommodate all dietary needs, we’ll let you know if you’ll need to supplement with your own foods.

Dietary restrictions *

1. No restriction 2. Vegetarian 3. Vegan 4. Gluten Free 5. Dairy Free 6. Will bring my own meals 7. Other - I will make comments below.

Food Allergies, if so what? Any other food information we should be aware of? *

Food Allergies, if so what? Any other food information we should be aware of?

Additional Information

Any other special needs, concerns we need to be aware of? *

Deposit Payment Options

Deposit - please pay 50% ($625) to reserve your spot. The balance is due two week prior. *

Pay by Check - send an email to Leslie ([email protected]) requesting her mailing address.

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Once you have completed this form please click the
"Submit" button to finalize your registration

SUBMIT

Rewiring Together in the Shenandoah Valley in Virginia is dedicated to supporting humans in the full joyful expression of their essential selves in the second half of life.

All rights reserved | Copyright@2025 | Watercolor paintings by Leslie Traub

Home
About Us
Testimonials
LOGISTICS
Registration
Rewiring Together Programs
Blog & News
Contact Us
About Us
Rewiring Programs
Rewiring Together for Men