Retreat Registration Form

Your Name (please make this the name of the person paying for the retreat below).*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email*

Enter Email Confirm Email

Your partner's name*

First Last

Your Partner's email

Enter Email Confirm Email

Your partner's phone number

How did you find out about this retreat?*

Any special requests/dietary requirements?*

Which retreat date do you want to sign up to?*

Conditions for registration*

Please tick the box below to indicate you fully agree to abide by these conditions.

Cancellation policy. A registration fee of £250 per couple is non-refundable. The balance will be due by 6th August. There will be no refunds for cancellations after this date

How would you like to pay for the workshop?*

Please sign us up for one couple's place on the "Getting The Love You Want" retreat*

Price:

Total

£ 0.00

Bank Transfer details Please pay the full amountto Dr. S. Slade Sort code : 51 50 00 Account number 64038815

For enquiries contact Bryan Greene at Bryan99greene@gmail.com or phone 01275 395215

Sophie Slade