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Retreat Registration
level27
2022-07-29T12:30:54-07:00
RETREAT REGISTRATION
TRAUMA INFORMED RETREAT
FOR KINSHIP, FOSTER AND ADOPTIVE MOMS
April 13-15th, 2023
Retreat Sign-up
First Name
*
Last Name
*
Address
*
Address
Address 1
Address 1
Address 2
Address 2
City
City
State/Province
Alabama
Alaska
Arkansas
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California
Colorado
Connecticut
Delaware
District of Columbia
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Hawaii
Idaho
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Indiana
Iowa
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Kentucky
Louisiana
Maine
Maryland
Massachusetts
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Mississippi
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Montana
Nebraska
Nevada
New Hampshire
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New York
North Carolina
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Ohio
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Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State/Province
Zip/Postal
Zip/Postal
Email
*
Phone
*
I would like to:
*
Attend the retreat
Sponsor another attendee
Choose Registration Type
*
Friday only (10am-5pm)
Name of person(s) you want to share with
*
Desired Roommates
Please enter the name(s) of up to three desired roommates. Note that we are unable to guarantee attendee placement, but will do our best to accommodate all requests. For the
Shared Queen bed
option, please indicate with whom you'd like to share.
Donation Amount
Please enter the amount you wish to donate.
Total
Refund Policy
: there are no refunds unless the retreat must be canceled or rescheduled due to Covid-19, retreat fees will then be refunded.
Payment Information
Credit Card
If you are human, leave this field blank.
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