First Name, Middle Initial and Last Name

Date of Birth

Email

Have you attended Human Behavioral Class with Candace?

Phone Number

Full Address (including ZIP or Postal Code)

How did you hear about this opportunity? If you were referred by a friend / student please provide their first and last name. 

What is your motivation for joining this retreat?

The investment for The Human Behavioral Retreat Level One Academy is $2,200. Please indicate your understanding and agreement to pay this amount in full prior to this Retreat in order to attend by writing "I AGREE" in the text box below. This will act as a binding legal contract.

If approved, please select your preferred payment option:

Please note: your payment must be received in full one month prior to the  start date. So if you select a 3 month payment plan today, the retreat must be happening after three months. 

2024 Planned Retreat Dates: 

March 14 - 17, 2024

September 5 - 8, 2024

Please indicate your understanding that upon approval of this contract, your initial payment (as indicated above) is due immediately and that there are no refunds:

Please indicate your understanding that as you are committing to attend this retreat in-person, you know that it is your responsibility to be there on time and for the entire experience and that if you are not able to attend for any reason, all payments are non-refundable. Any transfer of funds is solely decided by Candace Silvers and is subject to change at any time.