First Name

Last Name

Phone *

Email *

Date of birth

Number of participants:

Only me - 1

Coming with my spouse - 2

Coming with my children

If coming with Spouse or Children please list their names and date of birth

Additional notes or instructions, meal restrictions, etc.

I consent to receive SMS Notifications, Alerts & occasional communication from DMI. You can reply STOP to unsubscribe at any time.

You will receive an email with a link to pay a $50 registration fee to reserve your room at the retreat center.