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Journey to Justice

JOURNEY TO JUSTICE REGISTRATION FORM
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  First Name REQUIRED Please fill out this field. Please enter valid data.
  
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  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  How did you hear about us? REQUIRED Please fill out this field.
  
  Please describe any health concerns that we should be aware of during your stay? (dietary, physical or psychological). If there are none please state "None" REQUIRED Please fill out this field.
  
  Emergency Contact Name REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact Phone REQUIRED Please fill out this field. Please enter valid data.
  
  Reservations require a completed registration form and a deposit of $115 to secure your spot.
  Deposits are non-refundable. As a courtesy, we will transfer your deposit one time and within one year to another retreat. After one year, money not utilized for a retreat will be recorded as a gift to Loyola on the Potomac. Thank You.
  
  All Credit Card Payments now include a processing fee of approximately 3.5%.
  
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