Brattleboro aWALKening Retreat Registration
August 12-14, 2016

Participant Registration Form

Thank you for signing up for the 3-day aWALKening to Personal Leadership Retreat in Brattleboro, Vermont this summer. Within a few days of completing and submitting this registration, you will receive an invoice. We will continue to be in touch with you leading up to the retreat in order to prepare you for this "moving" experience.

We look forward to meeting you and spending this special time together - Kate Link & Marijne van den Kieboom

Question Title

1. Contact Information - If more than one person is in the registering party, each must complete this form.

Name *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Country *

Email Address *

Phone Number *

Question Title

2.
Select your method of payment: (Note: Lodging and meals are not provided. Snacks are.) aWALKening will donate a portion of proceeds to the Center for Health and Learning towards physical activity programs for children.

Cancellation Policy: Payments made will be refunded in full (less a $50 processing fee) if you cancel by June 30, 2016. If you cancel between July 1 and August 1, you will be charged $100 registration fee. No refund is available if you cancel after August 2 or leave the program early. Emergencies may be considered on a case-by case-basis.

PayPal (Invoice via PayPal will be sent)
Payment must be received by May 31, 2016: $295 - plus a 3.5% handling fee
Payment received after May 31, 2016: $350 - plus a 3.5% handling fee

Check: Payable to The CoachingLink. Send to: P.O. Box 6255, Brattleboro, VT 05301
Payment must be postmarked by May 31, 2016: $295
Payment postmarked after May 31, 2016: $350

A few scholarships may be available for Brattleboro area residents. PLEASE TELL US WHY YOU WANT TO ATTEND AND HOW MUCH YOU ARE ABLE TO PAY. You will be notified within two weeks of your Registration.

Question Title

3. Your experience with walking:

How often do you go for a walk?

How many miles or kilometers do you typically walk?

How many hours or minutes do you typically walk in a day?

What is the longest walk you have taken and when?

What was the most strenuous walk you have done and when?

What else would you like us to know about you and walking?

Question Title

4. What most interests you about the Retreat? What do you hope to learn or experience?

Question Title

5. Would you like to be placed on the aWALKening (Leadership in Motion) mailing list? (We promise not to clutter your inbox.)

Yes

Question Title

6. How did you find out about the aWALKening Retreat?

Facebook posting

LinkedIn posting

Center for Health and Learning

Inn at Water's Edge

Kate Link or Marijne van den Kieboom

Other (please specify)

Question Title

7. What questions do you have or what else would you like us to know about you?

By submitting this form you agree to the following:
1. I am in good physical condition and can walk a minimum of 4 miles in a day (broken into two walks with different paces accommodated) with potential for uphill walking. I do not suffer from any known disability or condition which would prevent or limit my participation in this aWALKening Retreat.

2. I understand that the aWALKening Retreat experience builds community. It is important to commit to attending sessions and participating in order to maintain the power and integrity of the community for myself and for others. I agree to be present when the group is convening and participate in aWALKening Retreat activities. (I recognize there will be designated time in the schedule for myself and non-Retreat activities of my own choosing.)

3. I agree to arrive by 1:30pm on Friday, August 12 and stay until the aWALKening Retreat ends at 3:30pm on Sunday, August 14, 2016.

4. I come to the aWALKening Retreat with curiosity and openness. I am interested in learning more about myself and understand that this might not always be what's most comfortable. I come ready to see myself and my life from new - or renewed - perspective(s).