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Registration Form
Queen Two
*
Indicates required field
Basic Info
Name
*
First
Last
Phone Number
*
Email
*
City and State
*
Hopes and reflections
Please specify any questions, concerns or reflections here:
*
Travel
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 food.
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
Total cost: $1250. If this cost is prohibitive for you, please ask us about our scholarship program.
Deposit - please pay 50% ($625) to reserve your spot. The balance is due two week prior.
*
Venmo - @Leslie-Traub
Pay by Check - will send an email to Leslie (
[email protected]
) requesting her mailing address.
Date of Course: November 1st-3rd
************************
Once you have completed this form please click the
"Submit" button to finalize your
registration
SUBMIT
Home
About Us
Testimonials
Logistics
Registration
Rewiring Together Programs
Rewiring Together Signature Program
Embodying The Queen
Mothers and Daughters: Rewiring Together
Rewiring Together for Men
Blog & News
Contact Us
About Us