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Registration for "Thriving beyond Cancer" series

You qualify to attend these one-day programs at Harmony Hill if:

  • You are a cancer survivor or a cancer caregiver
  • You are physically able to move between buildings and short distances

Priority will be given to those who have previously attended a cancer retreat at Harmony Hill; however, others who fit the criteria above can apply and will be invited to participate if space is still available two weeks in advance of the program.

To register, submit the online form below to reserve your space. Questions? Contact Victrinia Ensor, victrinia@harmonyhill.org, or by phone at 1-360-898-2363 during business hours.
Yes! I want to attend a "Thriving beyond Cancer" program

NOTE:
Registration for caregivers uses a different form.
Click for Caregivers registration for May 5 program

*First name

*Last name

*E-mail address

*Postal address

*City

*State

*Zip

*Home phone

Work phone
Program(s) you wish to attend:
Monday,April 28, 2008 - Thriving in Uncertainty
Monday May 5, 2008 - Caring for the Caregiver (cancer survivor registration)

Click for Caregivers registration for May 5 program
(uses a different form)
Monday, July 21, 2008 - Grief and Loss
Monday, October 6, 2008 - Loving Yourself through Cancer

Your birthdate

FemaleMale
*Have you ever attended a cancer program at Harmony Hill?
Yes No
If yes, list date(s) & program(s) you attended:
*How did you hear about this program?
*What is your cancer diagnosis?
(please be specific)
*Approximate date of your initial diagnosis
Dates of recurrence, if any

Do you have any metastasis? Any fractures and/or seizures due to metastasis?
If yes, please describe specifics:
*How are you currently feeling physically?
*Name of your primary medical doctor
*Doctor's address
*City & state

*Doctor's phone
List any physical limitations you have that may require that you have assistance in order to participate in the program (such as dizziness or lightheadedness, shortness of breath, difficulty walking on uneven surfaces or stairs)

We serve balanced, primarily vegetarian meals with occasional fish. List any nutritional concerns our staff should be aware of (such as allergies, don't eat fish, dairy, wheat):
In case of emergency, please contact:

*Name

Relationship to you

*Address

*city-state

*Phone:

day

evening
cell