Rewiring Together
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Registration Form
*
Indicates required field
Basic Info
Name
*
First
Last
Phone Number
*
Email
*
City and State
*
Date of Course
*
February 17-19 PRIVATE COURSE
March 17 - 19, 2023 FULL
May 5 - 7, 2023 1 REMAINING SPACE
September 8 - 10, 2023 OPEN
October 20 - 22, 2023 OPEN
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
Workshop is 85 miles due west from Washington D.C., and 75 minutes from Dulles International 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% ($375) to reserve your spot. The balance is due two week prior.
*
Paypal - rewiringtogether.org
Venmo - @Leslie-Traub
Pay by Check - will send an email to Leslie (rewiringtogether@gmail.com) requesting her mailing address.
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Once you have completed this form please click the
"Submit" button to finalize your
registration
SUBMIT
Home
About Us
Testimonials
Logistics
Registration
Contact Us
Participants
New Participants Pre-Work
What to Bring
Graduates
Blog & News