Women Food and God Retreat Registration Form

Women Food and God - The Retreat
Roth Retreats
Secure Online Registration
You can view this form without obligation to
submit payment
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Personal Information   
* Indicates
required information
First Name * 
Last Name * 
Address * 
State/Province * 
Zip/Postal Code * 
Country * 
    Phone (home)*

  Phone (cell)*

Date of Birth
Email Address


How did you hear about the retreat?


       If you selected workshop - which workshop?

Friend or Family Member

       If you selected other - please specify where.

May 2013 Tuition

Tuition Deposit (due upon registration): $595 (Tuition fee includes accommodations and all meals.)

Balance will be due (based on Room Type) by Feb. 19, 2013.

$1995 Double in Hotel
$1945 Double in Cabin
$1895 3-7 Person Rooms
$1845 Dorm (14 people)
$1795 Van/RV or Tent

Confirmation of Registration: You will receive email confirmation of your registration directly from Judy Ross, Manager, from Retreats@GeneenRoth.com. Your confirmation will include further information on the retreat, travel details to guide in making flight arrangements, and the special Asilomar Reservation form to book your accommodations (including meals) for the retreat.

Registration & Cancellation Policies

Registration Payment Policy:

  • $595 down payment ($350 non-refundable/non-transferable).
  • Payment by accepted credit cards or check (made payable to "Geneen Roth & Associates Inc.").
  • Balance of retreat fees are due 12 weeks before the first day of the retreat (February 19, 2013).

Cancellation Policy:

  • Cancellations must be requested in writing to "Geneen Roth & Associates, Inc." (email, fax, or USPS). Cancellations received 12 weeks or more prior to the first day of the retreat (by February 19, 2013): You will receive a full refund less a $350 non-refundable/non-transferable administration fee.
  • Cancellations received between 12-8 weeks prior to the first day of the retreat (by February, 19, 2013): You will receive a 50% credit of the registration fee to be transferred to the next scheduled Women Food and God Retreat with space available. This credit is available only if your cancelled space is filled with another registration prior to the start of the retreat. The credit is null and void if not used at the specified retreat.
  • Cancellations received less than 8 weeks in advance of the first day of the retreat (after March 19, 2013): No refunds, transfers or credits will be given for any reason.

I hereby confirm that I have read and understand the Registration & Cancellation Policies above and agree to these terms. I understand that these policies apply to this and future retreat registrations, unless revised by Geneen Roth & Associates, Inc.

Type Name & Date: 

I have read and agree to the contract terms.

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