FALL WELLNESS WEEKEND

Please fill out the form below to register for HWW's inaugural WELLNESS WEEKEND for women, Saturday, November 2nd, 2019 at Topping Rose House in Bridgehampton, NY. We invite women seeking the chance to grow, learn, laugh, indulge, explore, and inspire one another in a beautiful fall setting. Enjoy luxurious accomodations, renowned fitness and yoga classes, delicious local eats and wine, enlightening speakers, dynamic workshops, engaging activities, complimentary gifts, and R & R. Local day passes still available; space is limited and on a first-come basis.

Name *

Email Address *

City *

Age (must be 21+) *

Phone

How did you hear about this retreat? *

Have you ever been on a wellness retreat before? *

Yes

No

Any illnesses, injuries, allergies, or dietary restrictions, or special requirements that we should know about?

What are you seeking to gain from this retreat? Check all that apply. *

Please select below. Payment accepted in the form of credit card, paypal (processing fees do apply) Venmo upon arrival, or by check. *

Are you paying online (credit card or paypal) or by check? *

Online

Check or Venmo

Emergency Contact:

Name *

Phone *

Location *

Anything else that you would like us know about you that will help us get to know you?

Neither HWW or Topping Rose House are responsible for lost belongings and are not liable for loss, damage, or injury. I acknowledge that it is my responsibility to consult with my physician prior to and regarding my participation in any activities hosted during HWW's Wellness Weekend, November 2nd, 2019. If I need medical treatment, I agree to be financially responsible for any costs incurred as a result. I am aware and understand that I should carry my own health insurance. I am voluntarily participating in this program and I am aware of the risks associated with traveling to/from and participating in this retreat. I will not harass, harm, threaten, discriminate, dishonor, and/or injure those present during this retreat. I understand that if such occurs, I may be asked to leave immediately with no refund. All classes and workshops are subject to change. HWW reserves the right to provide a substitute of the same quality class or workshop. HWW reserves the right to photograph and share/utilize photographs for future marketing. I understand that this agreement is binding. *

I agree to the terms above

Please submit payment via credit card/paypal on the following screen or be prepared to Venmo upon arrival. *

I agree to the terms above