Clone of May 2026 Healing Summit Registration Form

October 2026 Healing Summit Registration

Please book for your conference by filling the form below, specify the expected number joining the conference.
Full Name

First NameLast Name
E-mail
example@example.com
What is your best contact number?
Please enter a valid phone number.Format: (000) 000-0000.
Which CO jurisdiction are you associated with?
What is your role within your jurisdiction?
Please share the name and best contact number as an emergency contact for you.
Do you have any physical, emotional, or mental health needs we should be aware of to support your retreat experience?
In case of emergency, do we have permission to take you to the nearest hospital for medical care/treatment?
The YMCA does not offer dietary supplements for celiac disease. They do, however offer alternative options like salad and non gluten at each meal. Should you need additional accommodations, you will need to bring food to support those. Are you in agreement to this.
Is there anything else you would like us to know before you stay with us?
Payments are processed through PayPal. You may pay using an existing PayPal account, or any major credit card / debit card.
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Registration
$1,750.00 Quantity

Registration for $1,000 Scholarship Recipients
$750.00 Quantity

Total

$0.00
Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

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October 2026 Healing Summit Registration