Register for Mending in the Mountains

Mending in the Mountains

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Registration Form

Name:  
Address:  
City:   State:   Zip:  
Daytime Phone:        Email:  

Additional Registration Information

How did you hear about this retreat?

Cancer Diagnosis:

Are you currently in treatment?

Type of treatment:

List any physical limitations including fatigue, flexibility, etc.:

Dietary restrictions?

Accommodations – Do you have a preference of who you room with? Do you need to be close to the Lodge for health reasons?

Is it important for you to have your own room?

Are you available to provide a ride or do you need a ride?

  

Participants currently receiving treatment must be under the care of an oncologist or other health care provider, and physically well enough to benefit from the program.

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Liability release forms and additional retreat information, including scheduling, directions, and confirmations will be mailed 2 weeks before the retreat.