Betty J. Borry Breast Cancer Retreats · New Participant Retreat Registration

Are you a first-time participant?

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Yes

No

If you are a RETURNING participant, please return to the registration form for alumna participants here.

Contact Information

Name

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First Name

Last Name

Date of birth

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(mm/dd/yyyy)

Preferred Phone

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Preferred Email

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Verify Email

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Preferred Address

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Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Error: Not a New England Resident

We're sorry, but retreats are currently open to NEW ENGLAND RESIDENTS ONLY. If you are a New England resident, please update your address and try again. If you submit your registration and you live outside of our service area, your registation submission will NOT be processed and you will receive a refund less a $25 administrative fee for any submitted payments.

General Questions

What best describes your current cancer status?

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How did you hear about us?

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T-Shirt Size - Women's Sizes Only

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Medium

Large

XL

2XL

3XL

4 XL

Retreat Payment

Retreat includes two nights lodging in a double occupancy room with ensuite bath, meals and snacks (including Friday's dinner, three meals on Saturday as well as breakfast and lunch on Sunday), and all programming for the weekend.

Are you applying for financial support? (Please note each participant is allowed ONE grant per year.)

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Yes

No

$ Amount of financial assistance requested

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Please describe your financial needs:

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Amount

$400 - Full Retreat Payment

$0 - Financial Support Requested (Payment balance may be due at a later time.)

$0 - Pay by Check (Send payment to: Betty J. Borry Breast Cancer Retreats, 21 Littlehale Road, Durham, NH 03824)

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I have read and agree to the cancellation policy.

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Cancellations made 30 days or more in advance of a retreat start date will receive full refund minus a $75.00 administrative fee. We do not offer refunds for cancellations made 29 days or less before the retreat start date unless we are able to fill the space with a waitlist participant. If we are able to fill the spot, the registration fee will be refunded minus a $75.00 administrative fee. In the event that a cancellation occurs due to illness, COVID, or other medical/immediate family emergencies, the registration fee will be refunded minus a $75.00 administrative fee. In the event we cancel due to failure to register the required minimum number of participants or any facility/weather/public health disaster, the total registration fee will be refunded.

I agree

Today's Date

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(mm/dd/yyyy)

New Participant Retreat Registration - Summer 2024

Contact Information

General Questions

Retreat Payment