Retreat Registration Form
The Reflection Center
Retreat Registration
Full Name
Full Address
e-mail address
Number of Attendees
Phone Number
Once we receive your registration form, we will contact you to
confirm your itinerary, attendance fees, etc.
Choose a Retreat Date
To Choose a Weekend Session (scroll down and highlight your selection)
Choose One or More Additional Services
(enter in Questions and Comments Box Below)
Massage Therapy = $75
Chakra Cleansing = $95
Meridian Evaluation = $95
Nutritional Consultation = $95
Numerology = $75
Chart of Feng Shui (one) = $65
Chart of Feng Shui (family of up to 4) = $110
Questions and Comments