COR Retreat Registration Form

Please complete the registration form below after submitting your payment.

Your payment secures your place at COR Retreat.

Date of COR Retreat*

First Name*

Last Name*

Gender

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?*

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, what is your experience with Overeaters Anonymous and/or other 12 Step programs?

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

How did you hear about COR Retreat?

If Other, Please Describe:

Payment Information: The registration fee for COR is $1,250 which covers all lodging, meals, and program materials at the retreat. You can pay online at www.cormn.org/register using PayPal or your credit card. If you want to pay by check, send your payment 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.