Community Weekend Online Registration Form

Woman Within® Eastern USA Annual Community Weekend

April 28-30, 2017 – Diamond Ridge Conference Center, Jamison, PA

Fees

(Remain at 2016 rates!)



Full Weekend



Saturday & Sunday Only



Saturday Only



Members

Paid 2017 dues, or 2016 and March 2017 Weekend Attendees

$175

$145

$99



Non-Members

Weekend Attendees (prior to December 2015) who have not yet paid 2017 dues

$220

$190

$144



Guests

Women who have not attended a WW Weekend and are interested in exploring our community

$185

$155

$109

Please include at least a $50 non-refundable deposit with this form.  (Payment Options Below)





Community Weekend Register Form


street address


Month & Year of WW Initiation Weekend



Dates



Payment Type



Informed Consent Form


Please Read & Check Box Below that you understand & agree.

I voluntarily consent to attend this Community Weekend and realize that I am responsible for my actions during this Weekend. I understand that there is always the risk of emotional and/or physical contingencies in such a group experience. I assume the risk, by this consent, of any accident or injury to myself or inflicted by me during the Weekend, and hereby release Woman Within Eastern USA and all its agents from liability therefrom.

I take responsibility for consulting with a medical doctor concerning any known or potential physical or mental condition, which I have or may have, for the purpose of getting medical permission to attend this Weekend. I assume the risk, by this consent of any illness during the Weekend, and hereby release Woman Within Eastern USA and all its agents from liability therefrom.

I hereby authorize the responsible staff to take any reasonable steps on my behalf in the case of an accident, injury, or illness, including, but not limited to emergency first aid, doctor, nurse and/or ambulance service, etc. I agree to be liable for the cost of any such action taken on my behalf, and hereby release Woman Within Eastern USA and all its agents from liability therefrom.

I agree not to consume alcohol and/or recreational drugs during the Weekend.


Agreement to Informed Consent


In case of emergency, please contact:



Submit Registration


To register for the Community Weekend, please fill out this form and click Submit at the bottom of the page.
You will have the option to pay with PayPal then.