Name *

First Name

Last Name

Email Communication *

I agree to receive email communication from HIATUS Retreats.

Yes

Phone

(###)

###

####

Which payment plan would you prefer? *

In full ($700 non-refundable deposit included)

Half now, half later ($800 non-refundable deposit included)

3-Installment payment plan ($900 non-refundable deposit now, remainder split evenly into 2 additional payments)

How would you like to pay? *

Venmo (HIATUS will send you a payment request)

Credit Card (3% transaction fee will be added to your total)

ACH Online ($25 flat fee per transaction)