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Cancer Retreat Interest & Registration Form

Below you will find both an online interest form as well as printable(pdf) registration forms. You will need to complete both. Before you fill out the forms below, please read the other important information on this page.

You qualify to attend a cancer retreat at Harmony Hill if:
  • You have received a cancer diagnosis at some time in your life, and can provide your physician's name and contact information

  • You are physically able to move between buildings and short distances

  • You have not attended a weekend cancer retreat held at Harmony Hill in the past 12 months
Space is limited to 20 participants in each retreat, and is filled on a first-come-first-served basis. Those placed on the waiting list will be notified as space becomes available.

Cancer participants may have one companion/support person attend with them for specified retreats only. All other retreats are limited to those with a cancer diagnosis. If you wish to bring a companion/support person, please list their name when you complete the interest form below.

Here's how you register:

1) In addition to the retreat interest form below, please complete this printable retreat application form (.pdf). If you do not have a printer or cannot print the form, please check the box on the interest form below and we'll mail it to you.

We ask each applicant to send in a $100 with their application. If a couple is applying, they would send in a $200 deposit. This deposit WILL NOT BE PROCESSED unless you cancel less than 30 days in advance of a retreat where you have a confirmed space on the roster (you would receive your deposit back if you have a medical or family emergency that prevents attendance). The deposit policy was put into place due to many last minute cancellations by registered participants, which contribute to increased staff time and administrative costs, and make it very difficult for those on the waiting list to make last minute plans to attend. Once you have attended a retreat, or cancelled within the parameters above, you will be contacted post-retreat and given the option to have your check or credit card charge slip shredded, returned to you or donated to support the cancer program.

2) If you wish to bring a companion/support person, also complete the companion application.

3) Complete and submit the interest form below to indicate your interest in attending a cancer retreat and your retreat date preferences. Submitting the interest form does not confirm your reservation - we will confirm your retreat date and reservation after we have received your printed retreat application form.

Questions?
Contact Victrinia Ridgeway, Program Coordinator, at victrinia@harmonyhill.org or by phone at 360-898-2363 during regular business hours.


Yes! I want to attend a Harmony Hill Cancer Retreat
This online form is an interest form. In order to confirm your retreat space, you must also complete the printable retreat application. (see above)

*Signifies required information Harmony Hill Privacy Policy

*First Name

   *Last Name   

*E-mail Address

*Mailing Address

*City

*State *Zip

*Home Phone

  Work Phone

How did you hear about this retreat?

Please check the appropriate box(es):
I have printed the full retreat participant application and will complete it and mail it

I have printed the companion application and will complete it and mail it

Please mail me the full retreat application so I can complete it

Please mail me the companion application so I can complete it


Do you wish to have a spouse/companion attend with you? A spouse/companion may attend with you only for retreat dates specified as open to spouses/companions. All other retreats are restricted to those with a cancer diagnosis.

NoYes    If yes, list their name:


Check up to three retreat date choices you'd be interested in attending:
     Jan 29-31, 2010
For men & women
Feb. 28-March 2, 2010
Women Only (Sun-Tues retreat)
March 21-23, 2010
For men & women
April 23-25, 2010
Caregiver Retreat
May 21-23, 2010
For men & women
June 11-13, 2010
Grief & Loss Retreat
July 30-Aug. 1, 2010
For men & women
Aug 27-29, 2010
For men & women
Sept. 19-21, 2010
For men & women
Oct 25-27, 2010
For women with breast cancer (Mon-Wed. retreat)
Nov 14-16, 2010
For men & women
Dec. 10-12, 2010
For Sexual Minority women
Remember: Submitting the interest form does not confirm your reservation - we will confirm your retreat date and reservation after we have received your printed retreat application form.