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Cancer caregiver's retreat interest form

You qualify to attend a cancer caregiver's retreat at Harmony Hill if:

  • You are currently a caregiver for a spouse, family member, loved one or friend with cancer, or are a professional caregiver for those with cancer; and
  • You are ambulatory

Space is limited to 20 participants, and is filled on a first-come-first-served basis. Those placed on the waiting list will be notified as space becomes available.

Here's how you register:

1) Download, print and complete the full caregiver retreat application form. (The form is an Adobe Acrobat file - free Acrobat reader) 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.

Last-minute cancellations 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. As a result, we ask each applicant to send in a $100 deposit with their application. This deposit will be returned to you upon your arrival at the retreat, and WILL NOT BE PROCESSED. We will retain the deposit only if you cancel less than 30 days in advance of the retreat, to help cover administrative costs resulting from late cancellations.

Once we receive your application and deposit, you will be notified via a confirmation e-mail or letter. We cannot place you on the workshop roster until your application and deposit are received at Harmony Hill.

2) Complete and submit the interest form below to indicate your interest in attending a caregiver retreat. Submitting the interest form does not confirm your reservation - we will confirm your reservation after we have received your printed retreat application form and refundable deposit.

Questions? Contact Cindy Shank, Program Manager, at cindy@harmonyhill.org or by phone at 360-898-2363 during regular business hours.


Yes! I want to attend the Harmony Hill Cancer Caregiver's Retreat
August 1-3, 2008.

* = required Harmony Hill Privacy Policy

*First name

*Last name

*E-mail address

*Postal address

*City

*State

*Zip

*Home phone

Work phone


This online form is an interest form. In order to confirm your retreat space, you must also complete the full retreat application.
*Please check the appropriate box(es):

I have printed the full caregiver retreat application and will complete it and mail it

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


*How did you hear about this retreat?