EnCOR Registration Form

Please complete the registration form below after submitting your deposit.

Date of EnCOR*

First Name*

Last Name*

Address*

City*

State*

Zip Code*

Phone*

Cell Phone

Email Address*

Emergency Contact Name and Phone*

How would you like your name to read on your name tag?*

Which COR Retreat did you attend? (COR #, Date of Retreat, etc.)*

Do you have any special needs, dietary restrictions or food allergies? (examples: Vegetarian, no red meat, no dairy, nut allergies, no or low-carb food plan, etc.)

Do you have any physical or mental health issues that we should be aware of? Any disabilities requiring accommodation?

Briefly, describe your recovery experience since leaving COR Retreat.

Please type your name below to accept the terms and conditions outlined below.*

Payment Information: The registration fee for EnCOR is $1,150, which covers all lodging, meals, and program materials at the retreat. A $100 deposit will hold your reservation to EnCOR. The balance of the registration fee is due one month before the retreat. Click here to make both payments via PayPal or your credit card. If you want to pay by check, send your payments with the completed registration form.

Cancellation Policy: COR Retreat has a limited capacity and our retreats frequently fill up with a waiting list. In consideration of the time and effort it takes for potential guests to make reasonable family, work and travel accomodations COR Retreat has the following cancellation policy:

If you cancel:
30 Days prior to and including retreat start date, your will receive a full refund
15-30 Days prior to the retreat, you will receive a 50% refund.
Less than 15 days prior to the retreat, will not receive a refund.

Disclaimer: I understand that COR Retreat does not warrant or agree to effect a cure from the effects of food addiction, but merely agrees to provide me a safe and supportive, mutual-help environment in which to share the principles in the Twelve-Step program of recovery. I understand that COR Retreat provides no clinical and/or counseling services and is not a replacement for a clinical or therapeutic treatment.