Register for a Woman Within Weekend

How will your life be different?
A Woman Within Weekend can bring you awareness you had not thought possible.

The Woman Within® Weekend will take you on a journey into yourself. This is our signature program.

Thank you for taking an important step by registering for the Woman Within® Weekend presented by Woman Within Western USA. Your place on the Woman Within Weekend will be reserved with a deposit of $200. After you submit this registration form, you will receive specific details and followup several days or weeks before the Weekend. Please note your responses are safe, secure and confidential.

Woman Within welcomes all women and prohibits discrimination based on race, color, gender, national origin, age, religion, disability, veteran’s status, sexual orientation and gender identity.

Step 1 of 3

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Choose your Weekend to Register*
We will announce when registration opens for upcoming Weekends. Check "Interested" on the events on Facebook for updates: Oracle, Ariz. Sept. 13—15; Nevada City, Calif. Nov. 1—3.
Name*
First Last
Preferred First Name
To be displayed on your name badge.
Preferred Name
To be displayed on your name badge
First Last
Email*
Enter Email Confirm Email
Preferred Phone Number*
Alternate Phone Number
Date of Birth (mm/dd/yyyy)*
Occupation*
Marital Status*
Single, Married, Widow, Divorced, Partner

About You
Do you have any dietary requirements?
Do you have any physical limitations or other restrictions?
Do you have a close friend or family member staffing or attending this Woman Within Weekend?
Add what is your relationship to her/them and is there anything else we need to know?
We will never ever share your private information with a third party. Your information will be used to inform you of the status of your registration, upcoming news, events, and workshops that we host You may opt out at any time by contacting communications@womanwithinwesternusa.org.
Sharing contact info*
In order to share travel arrangements and follow up after the Weekend, my contact email and phone can be shared with other women attending the Woman Within Weekend.
- I agree
- No sharing with other participants please.
Amount*
To reserve your spot, payment in full or a deposit of $200 needs to be received. PayPal will confirm payment directly to you.
Financial aid cannot be applied to the non-refundable deposits. If you apply for a scholarship, please pay the initial deposit and we will be in touch shortly with financial assistance details.
- Initial Deposit of $200
- Full Payment of $725

Payment
Total
$0.00
How will you be paying for the weekend?*
Select one of the payment options below. We prefer paying by check since it avoids bank charges. Makes check payable to Woman Within Western USA, and mail to Michelle Reilly, 3038 Wing Street, San Diego, CA 92110. If you are paying by credit card you will be asked for credit card's billing address.
- Credit Card
- Check
The cost of the Woman Within® Weekend is $725, beginning September 2018. This includes a $200 non-refundable, non-transferable registration fee*. This fee covers tuition, lodging, meals, snacks and Weekend materials.

How to pay by Mail-in Check

Please include name and weekend title/date as reference. eg. M Smith WW May 2016

Checks to: Woman Within Western USA c/o Michelle Reilly. 3038 Wing St, San Diego, CA 92110
Mailing Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Woman Within welcomes all women and prohibits discrimination based on race, color, gender, national origin, age, religion, disability, veteran’s status, sexual orientation and gender identity.
Our cancellation policy :

A $200.00 NON-REFUNDABLE, NON-TRANSFERABLE DEPOSIT RESERVES YOUR PLACE, with the balance due no later than four weeks prior to the weekend date. If you register less than four weeks prior to the training, payment must be completed within two weeks of receipt of the registration packet you receive by mail. Payment in full must be completed or a payment plan in place with the ScholarshipCommittee before you attend the Woman Within weekend. We will refund your paid fee (less the $200.00 deposit) if we receive your cancellation notice in writing no less than 21 business days prior to the first day of the weekend for which you have paid. If cancelled after that time, your paid fee (less the $200.00 deposit) will be transferred to another weekend of your choice within one year of your initial registration. Please be advised that a "no-show" without any prior notice will result in a forfeit of tuition.
Untitled
Name
This field is for validation purposes and should be left unchanged.

Register for a Woman Within Weekend

How will your life be different? A Woman Within Weekend can bring you awareness you had not thought possible.

Step 1 of 3

About You

Payment

How will your life be different?
A Woman Within Weekend can bring you awareness you had not thought possible.