Intensive Health Retreat Registration

First Name

Last Name

Street Address

City

State/Province

Zip/Postal Code

Home Phone

Cellphone

Email

Medical Condition

Date of Birth
MonthDayYear

Room Options
(depending on availability)

Height

Weight

Sex

Insurance Type

Date of Session

Payment Method

Payment Amount
Payment Policy

 I have read and understand the payment policy listed to the right of this form
How did you find out about the Retreat?

Please note that your registration is not complete until payment has been received.

The Rudolf Steiner Health Center is not responsible for any lost travel or program costs. Please make sure all travel purchases are refundable. Deposits and payments are nonrefundable, so please purchase travel insurance to cover any lost travel and program costs if you are unable to attend. Generally, travel insurance needs to be purchased before you register. Call Travelex at  (800) 228-9792 or any travel agency for a quote specific to your needs. Payments received less than 7 days before the session you are attending will incur an additional $250 late registration fee. In the rare case that retreat dates are changed or cancelled, the health center will refund all program costs but is not responsible for travel costs, so please make sure your travel is refundable or covered by travel insurance.

 

Please Make Checks out to:
RSHC

Mail Checks to:
Rudolf Steiner Health Center,
1422 W. Liberty St.
Ann Arbor, MI 48103

We will telephone you for credit card information.