2024 Women's Weekend Registration Form

First Name *

Last Name *

Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

Age *

If this is your first Women's Weekend or your 5th, what drew you to consider signing up for 2024?

Please share 3 adjectives that you feel describe the way others see you and 3 ways you see yourself. *

Are you coming with others? Please share cottage mates.

Would you be interested in participating in an art workshop? Medium TBD. Stay tuned! *

Yes

No

Would you be interested in more of an adventure based experience? Hike, lake excursion, mountain bike adventure.... *

Yes

No

Would you be interested in participating in a fly casting clinic. Minimum number of 5 participants required to conduct the class. *

Yes

No

Would you like to sign up for yoga Saturday and or Sunday morning? *

Yes

No

Would you like to sign up for a massage? (1hr - $95) *

Yes

No

Would you like a Women's Weekend T? (additional $30) Please specify size below in adult women, men or unisex.

Do you have any dietary needs we should be made aware of? *

How did you hear about us? *

Deposit Information: A 40% deposit is required to hold your spot (Total cost $550.00 plus 9% VT. Tax). The deposit may be paid via credit card, or check. However, we would prefer the remaining balance be paid via check. Please select how you would like to pay your deposit: *

Credit Card

Check

Please mail checks to: C/O Lilly Devlin: Quimby Country, 1634 Rt 30, Cornwall, VT. 05753

Credit Card Number (We accept Visa, Mastercard and Discover)

Expiration Date (Month and year)

CVV number (the 3-4 digit number on the back of your credit card)

If you have participated in Women's Weekend in the past, is there anything you would like to see included in the weekend? *

2024 Women’s Weekend Registration Form

Quimby Country 2024 Women's Retreat