Retreat Registration Form

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current date

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Event Dates

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Complimentary Room Date

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Payment Due Date

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Registration Manager

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Registration Manager Email

Register For:*

Deluxe Individual - $1250.00
Deluxe Couples - $1750.00
Standard Individual - $675.00
A la Carte

# of A la Carte Attendees*

Please enter a number from 1 to 4.

Attendee Information

Attendee #1

Name*

Company / Organization

Leader of Colorado Donor or Higher ($150 or higher)?*

Yes
No

Leader of Colorado Discount Code*

With your code, you will receive 5% off the total of your Retreat Registration costs. If you have not received your code, please call 303.488.0018.

President's Club Level Donor or Higher?*

President's Club Level Donors or Higher receive an additional discount on PLUGin tickets equivalent to $10 off the $75 per ticket price in addition to your 5% off the total registration price.

Yes
No

LPR or RLP Alumni?*

Yes
No

Graduation Year?*

Purchase Plug-In Event Tickets?*

Tickets are $75.00 each

One Ticket
Two Tickets
None

Hidden

VIP Reception*

No

Friday Dinner*

Yes $475.00
No

Saturday Lunch*

Yes $275.00
No

Sessions*

Yes $295.00
No

Attendee #2 Information

Name*

Company / Organization

LPR or RLP Alumni?*

Yes
No

Graduation Year?*

Purchase Plug-In Event Tickets?*

Tickets are $75.00 each

One Ticket
Two Tickets
None

Hidden

VIP Reception*

No

Friday Dinner*

Yes $475.00
No

Saturday Lunch*

Yes $275.00
No

Sessions*

Yes $295.00
No

Attendee #3 Information

Name*

Company / Organization

LPR or RLP Alumni?*

Yes
No

Graduation Year?*

Purchase Plug-In Event Tickets?*

Tickets are $75.00 each

One Ticket
Two Tickets
None

Hidden

VIP Reception*

No

Friday Dinner*

Yes $475.00
No

Saturday Lunch*

Yes $275.00
No

Sessions*

Yes $295.00
No

Attendee #4 Information

Name*

Company / Organization

LPR or RLP Alumni?*

Yes
No

Graduation Year?*

Purchase Plug-In Event Tickets?*

Tickets are $75.00 each

One Ticket
Two Tickets
None

Hidden

VIP Reception*

No

Friday Dinner*

Yes $475.00
No

Saturday Lunch*

Yes $275.00
No

Sessions*

Yes $295.00
No

Hidden

Total Amount

Total

$0.00

Billing Information

Name*

Address*

Company or Organization

Email*

Enter Email Confirm Email

Phone*

How Did You Hear About the Retreat?*

Other*

Payment Options

Payment Options*

Credit Card Online
Mail-in Check or Money Order

Credit Card*

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Please be sure to mail your check or money order to:

Leadership Program of the Rockies

1777 South Harrison Street, Suite 807

Denver, CO 80210

Click submit to complete your registration pledge. Please note, where spots are limited, places cannot be reserved until payment is received in full.

REGISTRATION CLOSES February 6th!

Friday evening Broadmoor rooms are sold out please contact Stephanie Muth at [email protected]org for more information on registering

Attendee Information

Attendee #1

Attendee #2 Information

Attendee #3 Information

Attendee #4 Information

Total Amount

Billing Information

Payment Options