Adoption Healing...                       

25 years of helping those whose lives have have been touched by adoption

Healing Weekend Registration        

*** Please do not make airline reservations until we confirm your weekend.           SiteLock

If you are paying by Credit Card, the address you give must be the address at which you receive your Credit Card Bill.

   *  = Required
 *  Salutation   Mr.    Mrs.     Ms.        First:                 Last:
  Street 1:                Street 2 :
 * City:      State/Province            Zip:       * Country:
  Home Phone.:     Business Phone.:  * I am Adoptee     Natural Parent
* E-mail:  *    Confirm  E-mail:
*  I wish to borrow a sleeping bag   Do you have a car?
 
* Food Requirements:       Do you any special requirements ?
*   By placing an 'X' in the box to the left, I agree to wait until my weekend is confirmed to make my travel arrangements and I assume all responsibility for my travel costs.
*   By placing an 'X' in the box to the left, I  agree to the following 2 items:  1.)  I understand and agree that the fees for these weekends are non-refundable.  2.)   If a replacement for my spot is found, a $75 cancellation fee will be charged and the remainder of the  fee that I paid  will be applied to a future weekend.. else the fee is forfeited.
We suggest you take out travel insurance to protect yourself in case you are unable to attend.

 *   Healing Weekend $200 USD (Non-Refundable)     ($ 235 for 2019)   $150 deposit required
   
  Reunited Pairs Weekend $300 USD (Non-Refundable)                            $150 deposit required  
   
  Healing/Vacation Week in Caribbean $999 USD (Non-Refundable)       $500 deposit required

Date of Weekend          Your balance is due four weeks prior to your weekend

Payment Information          

Amount of Payment             Pay by      Name on Card  
Card Number    Card Expires        Security Code  What is the security code?
                      If you are Not paying by credit card, enter 00 in the Security Code Box above.
Please press the SUBMIT button below

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Signature _______________________________________        Date ________________

You may make your payment by faxing your Name and Credit Card info to: 845-267-2736,
or you may call 845-268-0283 and leave the info on our answering machine, or you may send the payment via US Mail


You must, no matter how you pay, send this form with your signature and date of signing to us by fax or to mail it us at the address below

Adoption Healing, 74 Lakewood Drive  Congers, NY 10920-1710

If paying by check, make the check out to Adoption Healing.


   E-mail us at joesoll@adoptionhealing.commailboxFormMail  

Last Updated on April 1, 2011 by Joe Soll                         Copyright 2011 Adoption Healing all rights reserved; logo's and graphics appearing on these pages are trademarks of Adoption Healing and may not be used or reproduced without permission.