Registration St. John 2025 – Heart-Based Mindfulness

Name

First

Last

Email

Confirm Email

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone number

How did you hear about this Retreat?

Email from Kate Mitcheom / Heart-Based Mindfulness
Saw on Kate’s website
Friend told me
Other

Please explain. Thank you!

My accommodation choice is:

Double Occupancy ($2125)
Single Occupancy ($3225)

If Double Occupancy, please select one:

I would like to be assigned a roommate
I already have a roommate

Name of my roommate

For rooming assignment purposes, do you identify as

Male
Female

If you are not traveling with someone you would like to share a room with, we will pair you with another solo traveler. If no one is available, single occupancy supplement will apply.

$150 non-refundable deposit due at time of registration

Kate will contact you for remaining balance.

Venmo, Zelle or checks preferred. Credit card also optional

I plan to pay the $150.00 deposit by:

Check
Venmo: @Kate-mitcheom
Zelle: @Kate Mitcheom
Credit Card via PayPal

Your non-refundable deposit of $150 is due immediately following registration.

I understand that my space is not reserved until Kate Mitcheom receives my check at the address listed below.

Please make your $150.00 check payable to Kate Mitcheom and mail to:

Kate Mitcheom
17 Haycock Point Road
East Branford, CT 06405

Your deposit of $150 via Venmo is due immediately following registration.

I understand that my space is not reserved until Kate Mitcheom receives my Venmo payment.

Venmo = @Kate-mitcheom

Your deposit of $150 via Zelle is due immediately following registration.

I understand that my space is not reserved until Kate Mitcheom receives my Venmo payment.

Zelle = @Kate Mitcheom

Your deposit of $150 via credit card is due immediately following registration.

I understand that my space is not reserved until Kate Mitcheom receives my credit card payment.

After submission of this form, you will be sent to PayPal to complete your payment. Your deposit of $150 via credit card is due immediately following registration.
No need to have a PayPal account. You may choose “Pay with debit or credit card” and check out as Guest.

Total to be collected by credit card today

Price: $150.00

Balance of Retreat reminder

I understand my balance due October 30, 2024.

Kindly note that NO REFUNDS will be made.
We recommend you consider buying travel protection insurance. Learn more

Questions or comments? Please share below.

I can’t wait to see you in January!

Kate