Registration Name Date of Birth Mailing Address City State Zip Code Email Address Phone Number What do you hope to experience in this Healthy Habits Retreat? How much weight would you like to lose? How will your life change when you achieve your goal? What aspect of the retreat are you the most drawn to: Please Select One: Healthy Weight Healthy Spirituality Healthy Movement Healthy Relationships Do you anticipate any health or medical problems from spending a week in a mountain setting (8900 feet)? Yes No Describe any dietary restrictions or food allergies? Describe any physical limitations that may impact your participation? Would you be able to climb one floor of stairs to reach your bedroom? Yes No What other medical condition would you like to share with us to help plan your program? Are you willing to share a room ($200 less for the 6 days) or do you prefer your own room? Share Prefer own room Do you have a supportive spouse/partner? Yes No Would he or she like to attend as well (discounted rate if you share a queen bed)? Yes No Register for the Healthy Habits of Life Weight Loss Retreat is as easy as completing the application and hitting the submit button. Contact facilities manager Michele at 303 747 2358 or Teresa at 303 747 2691 to submit a deposit to guarantee your space.