Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I am a HCI Network Member *

HCI Network Members receive a $20 registration discount. You must have completed all of the membership process to be eligible for this discount.

I am a member.

I am not a member.

Leadership Retreat Workbook *

I would just like the PDF copy of the workbook included with the registration fee.

I will purchase a hard copy of the workbook at checkout. (additional $30)

Payment Submission *

Registration is complete only once payment has been received.

I will pay online via PayPal.

I will submit my payment by mail via check.

I have spoken to someone at HCI to arrange other accommodations.

Would you like to stay in-touch?

I understand that HCI will be contacting me with information about the retreat. Tick this box if you would also like to give permission for HCI to use my information to contact me about classes, events, news and more!

Yes, I'd like to be updated!

I understand each session will be recorded on Zoom. *

I am aware that each session, excluding the breakout rooms, will be recorded for attendees to have access to rewatch. If I prefer to not be seen or heard during recording, I will turn off my camera and mic. If I feel like I shared sensitive information during a session, I will contact HCI and ask them to remove what I said. I understand that HCI will do their best to accommodate my request.

Yes, I understand.