Provider Retreat Registration | HeartwoodExpeditions

Provider Retreat Registration Form

First name

Last name

Preferred pronouns

Phone

How did you hear about us?

What is your experience in the outdoors? Do you have any concerns about the event?

What are you hoping to get out of this experience? What are you most looking forward to?

Do you have any current medical conditions or past pertinent medical history? Please include any asthma or allergy related conditions.

Do you have any dietary restrictions?

I have read the Heartwood Expeditions waiver in its entirety and accept and consent to the conditions stated.

Saturday Cost: $70

Saturday & Sunday Cost: $130

If you are signed up for worktrade please deduct $30 per hour you plan to volunteer.

Enter the amount you wish to pay:

Please add me to the Heartwood mailing list