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A Guided Journey of Reckoning and Reconciliation between Veterans and Civilians for the Healing of Moral and Ethical Injury Associated with Post Traumatic Soul Distress.

JOIN OUR NEXT JOURNEY

OR CHOOSE FROM FUTURE JOURNEYS

Please Complete The Form Below

All information will be kept absolutely confidential and for our use for the Veteran’s Healing Journey and Journey follow-up only.

PLEASE BE AWARE: All our retreat sites require proof of vaccination.

Elder Warrior Registration

Registration for Veteran's Healing Journey

Please Choose Your Healing Journey

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Cell Phone *

Home Phone

Occupation or Profession

Email *

Email

Confirm Email

Gender *

Birthdate mm/dd/yyyy *

Emergency Contact *

First

Last

Emergency Contact Phone *

Are you… (check all that apply) *

Active duty
Veteran
Military family member
Counseling professional
Clergy
Concerned citizen

Rank

Branch of Service

Area of Operation

Time of Service

Have you been in combat?

Yes
No

Where have you been in combat?

Have you experienced (check all that apply)

Military Sexual Trauma (MST)
Traumatic Brain Injury (TBI)

Have you worked with the military?

Yes
No

In what capacity have you worked with the military?

Do you have any food restrictions or disability restrictions affecting your room or special needs? *

Yes
No

Please list any special needs

Any questions?

Any other information you feel we should know?

Please enter first name only of spouses, children, parents, or close family and their relationship to you for use in one of the rituals. None will be contacted in any way.

Please Choose Your Option

Single Room – $800.00
Scholarship Request – $0.00

(Room costs include tuition for the retreat. Scholarships are available.)

Donation

(Please fill in desired donation amount if any.)

Will you be applying for a complete or partial scholarship?

Yes
No

(Final determination will be made following the interview process.)

Total

$0.00

Please click submit to complete your registration form and follow the instructions on the pop-up to submit your payment.

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