Retreat Registration Form

(Required fields are marked with a red asterisk. $25 non-refundable registration fee, payable after you submit the form. Balance due six weeks before retreat.)

Which Retreat? *

Select the retreat you want to attend from the dropdown box.

Name *

Address *

Country

City

State

Zip code

Email *

Preferred Phone Number *

Other phone number

Emergency Contact Name *

Emergency Contact Phone *

Why are you attending the retreat?

Are you (check all that apply):

Active duty

Veteran

Military family member

Counseling professional

Clergy

Concerned citizen

When and where did you serve?

Have you been in combat?

Yes

Have you experienced military sexual trauma (MST)?

Yes

Were you exposed to non-combat war trauma (mortuary, funeral, weapons, etc.)?

Are you a non-veteran survivor or refugee of a combat zone? If yes, when and where?

If your family member or loved one is active duty or veteran, please tell how you are related (spouse, child, parent, etc.).

Please describe any experience you have working with veterans.

Have you read (check all that apply):

War and the Soul by Dr. Ed Tick

Warrior's Return by Dr. Ed Tick

Please explain any dietary restrictions.

Please describe special accommodations, if any, needed for disabilities.

There is a $25 non-refundable registration fee. For details on total cost of retreat, see retreat description, or contact info@soldiersheart.net.

After you submit this form, you will be prompted to pay the $25 registration fee. Even if the retreat is free or you are applying for financial assistance, you must pay the $25 registration fee. Fee can be paid by check, money order, credit card, or Paypal.

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