Lifestyle Health Retreat Application

Pathway to Peace Lifestyle Health Retreat

Application / Reservation

704-465-8500 / info@pathwaytopeace.net

Please call to confirm reservation before you submit your deposit via mail or online

Select Lifestyle Program Attending: *

Session Dates Attending *

Name *

Spouse/Friend attending with you

Home Phone *

Mobile Phone *

E-mail *

Address *

City *

State *

Zip *

Country *

Birth Date *

Age *

Gender * Male Female

Please explain health concerns (if any) *

Food Allergies (if any)

Please make sure we have your current email. After your application/reservation has been accepted and your deposit submitted, we will send you a Lifestyle Health assessment questionnaire to prep for your stay with us. May God Bless you and we are excited about having you as our guest!