Freedom of Expression retreat
Registration by end of day Friday, October 6, 2023 was especially helpful! Thank you!
To help us have adequate supplies, registration by end of day Wednesday, October 11 is very helpful.
This registration form closes by 6:00pm on Thursday, October 12.
After that you can register at the retreat.
However, additional details will be emailed to those who register by October 11.

Saturday, October 14, 2023
Starts at 10:00am & ends at 5:30pm
at The Light Center https://lightcenter.info/
Info on the About & Discussion tabs at https://www.facebook.com/events/1534489573987363
Other questions? Contact Marcia at M.Epstein.LMSW@gmail.com
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1. Your First and Last Name, please.  *
2. We apologize to those with limited mobility, as The Light Center grounds include uneven surfaces, and the retreat building includes a 2nd floor meeting room accessed by stairs.  Does this work for you?
 *
3. For Your Person or People whose death by suicide brings you to this retreat:
Their Name(s) and Relationship/Connection (friend, mentor, child, partner, sibling, parent, ...) to You *
4. Your Cell Phone Number using 10 digits *
5. Your Email Address *
6. City and State where you live *
7.a. Are you 18 or Older by 10/14/2023?  
Note: Participants under 18 are welcome when accompanied by adult Friend-Family *
Required
7.b. For those under 18: Please list your age on 10/14/2023 and the adult Friend-Family who is attending with you.
8. Foods and beverages provided include options for vegan, vegetarian, gluten-free, and omnivore diets.
If you have other dietary needs, please identify those, so together we can determine how to meet those. *

9. We suggest a donation of $40 or more per person who is able. This helps with retreat expenses, including scholarships for participants who cannot donate.  Thanks!

 *
Required
10. Are you likely to participate in afternoon session of yoga, trauma-informed & restorative yoga led by Marcia's friend Emily Overland?
If yes, will you bring your yoga mat? (Some are available at The Light Center.)
https://www.overlandcounseling.com/ *
11. How did you learn about this retreat? *
💜💙  We look forward to spending this retreat time with everyone who participates. And we know that each participant's presence is helpful to everyone there. Thank you for being part of this goodness!
💜💙  We intend to email each person within a week after registration. And during the week of the retreat, we will email all who registered. For more info before the retreat, please read posts on the DISCUSSION tab at
https://www.facebook.com/events/1534489573987363
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