Event Application Form

Basic Information

Title

Name

First Name

Last Name

Suffix

Preferred Name

Job Title

Company/Organization

Organization Type

Primary Industry

Linkedin URL

http://

Contact Information

Phone

Country

(###)

###

####

Preferred Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

My billing address is the same as my mailing address?

Yes

Scholarships

There may be a limited number of partial and full scholarships available.

Are you interested in being placed on a waitlist to be considered for a scholarship?

Yes

Demographic Information

(to help us assemble the widest range of perspectives at the retreat)

Area of Expertise

Race/Ethnicity

Gender

Birthdate

YYYY

If you selected "Prefer to Self Describe" for any of the demographic questions above, or you'd like to share anything else that is relevant to know about you, please use this space to do so.

Please share about who you are and why you are interested in attending this retreat:

(300 words max)

Costs to Attend the 3-Day Retreat for Restoration and Integration

Full participant = $3,500. If accepted, we ask that you make payment in full within 10 days to hold your spot. If you need to make alternative arrangements please email info@daysixleadership.com

3-Day Retreat for Restoration and Integration Cancellation Policy

There is a $500 non-refundable administrative fee. 121+ days before the first day of the retreat - refund of paid participant fee less $1500 (inclusive of $500 non-refundable administrative fee). 120 days or less before the first day of the retreat - No refund of paid participant fee

Cancellation Agreement

I have read and agree to the terms of the 3-Day Retreat for Restoration and Integration Cancellation Policy

I Agree

I Do Not Agree

3-Day Retreat for Restoration and Integration Designed for Leaders
Seeking Reflection, Renewal, and Connection

Friday, December 6th - Monday, 9th, 2024 | Lone Rock Retreat Center | Bailey, Colorado