ChargeKeep | Payment Form

Amount (USD)

One-Time payment

The Self-Love Retreat for Black Women: Reclaiming Self, Sisterhood & Sensual Space

$300 DEPOSIT IS REQUIRED TO CONFIRM YOUR SPOT. The entire balance must be paid in full by or before March 22, 2024. A payment schedule will be provided once your spot has been confirmed. Use the drop down to manually enter your subsequent payment amounts. All deposits and payments are non-refundable.

Name

NAME *

EMAIL *

AGE *

How did you learn about this retreat? *

Tell us one goal you have for each of the following areas: reclaiming self, sisterhood, your sensual space *

Why are you a good fit for this retreat? *

Do you have any dietary restrictions or food allergies? *

I understand that all payments and deposits are non-refundable. *

YES

I understand I am responsible for my transportation to and from this destination. *

YES

Are you local to the upstate NY region? *

Yes

Card Number

Expiration Date

CVC