Women Beyond Cancer - Retreats & Events

2012 Retreat Schedule and Application

2012 RETREAT SCHEDULE

APRIL 19-22 MOAB, UTAH - ARCHES NATIONAL PARK ADVENTURE RETREAT

SEPTEMBER 21-23 EAST ORLAND, MAINE YOGA AND NUTRITION RETREAT

OCTOBER 18-21 ZIONS NATIONAL PARK ADVENTURE RETREAT

DECEMBER 7-9 PARK CITY, UTAH MOUNTAIN CHALET RETREAT

DUE TO MEDICAL ISSUES OUR TWO SISTERS FARM RETREAT IS TO BE DETERMINED

TWO SISTERS FARM

MOAB, UTAH

ISLAND PARK, IDAHO

A $50 dollar refundable deposit is required prior to securing a spot at our retreat.

Location of Retreat
Date of Retreat
Name
City and State
Address
Zip Code
Daytime Phone	() -
Evening Phone	() -
Cell Number	() -
E-mail Address
Type of Cancer
Date of Diagnosis
Treatement/Dates
How you heard about us
Emergency Contact/Phone
Date of Birth
Special Dietary Needs
Other Special Needs
Attending Physician
Physician Emergency contact number
Current Medications
List any retreats you have attended in the past either through WBC or another organization
By writing yes do you hold Women Beyond Cancer harmless should you attend our retreat?
By writing "yes" I understand that there is absolutely no drinking at any WBC retreat.
By writing "yes" I understand that I may not bring my pet to any WBC retreat
By writing yes I understand that any picture taken of me at retreat may be used at the sole discretion of Women Beyond Cancer. If not agreeable I will not sign up for a retreat
By writing yes I understand there may be a phone intereview conducted to discuss possiblity of attending a WBC retreat.
Comments

Tax ID #20-0683491

Contact Chris Powers for more info at (803) 646-0123

Women Beyond Cancer

PO Box 680940

Park City, UT

84068