Please complete the form below to register! All fields are required.

"​" indicates required fields

Name​
Date of Birth​
Emergency Contact Name​
Dr. Keelin Regan-Reed, Amber Roth, Sarah Krom, Martha Walker, Kathleen Pecoraro - Name of a Friend, Social Media, Newsletter, Website?
Have you ever been treated by (please check all that apply)​

Pricing

*If you are sharing a room with a partner/friend, please book shared room for each of you. Shared rooms must be known participants only.
Price: $3,850.00
Price: $3,600.00