Elm City Wellness Expeditions & Sacred Journeys

Registration Form

Name *
Address *
Phone *
Emergency Contact
Emergency Contact Name
Emergency Contact Name
Emergency Contact Phone
Emergency Contact Phone
Special Needs
I require a special diet. *
Accommodation Options *
Payment Options
A non-refundable deposit of $500 is due by March 1, 2017. Final payment is due April 15, 2017. *
If you choose to only pay the deposit at this time, we will contact you the week of April 15 to authorize payment for the remaining balance.
Please note that payment is required for registration. *
Please make out all checks to Elm City Wellness and mail to: Elm City Wellness, 774 Orange St., New Haven, CT 06512
I agree to the Terms & Conditions *

*Click HERE to read our Terms & Conditions.