Rewiring Together
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Registration Form
Embodying The Queen
November 1-3
*
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.
*
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
Our Programs
Embodying The Queen
Mothers and Daughters: Rewiring Together
Rewiring Together for Men
Registration
Register for Embodying the Queen
Register for Mothers and Daughters: Rewiring Together
Register for Rewiring Together for Men
Blog & News
Contact Us
Logistics
Participants
What to Bring
New Participants Pre-Work
Queens II
Home