2018 retreat Registration

Name *
Name
Phone *
Phone
Address *
Address
Please select three small group therapy session you would be most interested in attending? *
*Only choose up to 3
Are you interested in optional retreat services or activities?
*for an additional fee
What are your retreat expectations? *
Select only your top 3.
I agree that I have read and acknowledged the disclaimer below. *
The Mind Body Melanin Wellness Retreat is created for and intended for women of color. Retreat content and discussion topics are primarily tailored for women of color. Mind Body Melanin does not and shall not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, in any of its activities or operations.
By checking ‘Yes, I agree’ you are acknowledging that you have read and understood the retreat attendee policy and the travel waiver (below). You fully agree and understand all terms and conditions. *

*2018 MBM Retreat Attendee Policy and Travel Waiver: click here to read and review,