Copy of Cream and Peach Minimalist Leadership Retreat Business Presentation (2).png

Charleston Retreat Registration Form

Registration is required for each attendee.

Registrant Information

First Name

Last Name

Phone Number

T-Shirt Size

What makes you excited about the 2026 Epitome of Epilepsy Retreat?

What do you look forward to learning, experiencing, enjoying?

Caregiver Companion

A Caregiver Companion is an adult who attends the retreat location with a participant to offer personal support. While they are welcome on-site, they do not participate in retreat activities and are not required to pay a registration fee. Caregiver Companions are responsible for their own expenses, such as lodging, meals, and transportation. Their purpose is to support the participant throughout the retreat.

I will have a caregiver companion attending

Emergency Contacts

Please list at least one person who can be contacted in the event of an emergency when you cannot be reached. The first emergency contact must live within one hour of the retreat center or home, be at least 18 years old, and be able and willing to take responsibility for the child if the parent or guardian cannot be reached. Additional contacts, while optional, should also be able to assist in reaching you or providing temporary support.

Emergency Contact #1

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Age

Emergency Contact Address

Country/Region

Address

City

Zip / Postal code

Emergency Contact Primary Phone

Emergency Contact Secondary Phone

Relationship to Registrant

Payment and Statement of Understanding

The registration fee is $250, or you may choose a two-payment plan of $150 each. The First Installment is due at registration, and the Second Installment is due by March 1st. All payments are non-refundable.

(Second Installments can be made via our "Events" page.)

Registration Options

Early Bird Registration$250

First Installment$150