Workshop and Retreat for Military and Responder Couples

Workshop and Retreat for Military and Responder Couples - Future Event

IMPORTANT: Submitting this form does not guarantee your registration.

Upon completion of the Interest Form, you will receive an email detailing your next steps.

Select the event date you would like to register for:

Future Event: Please submit your completed interest form to be contacted when future event dates are available.

Interest Type

Emergency Responder CoupleMilitary Couple At least one of us is an emergency responder or active or veteran military. We are both available for the Kickoff AND the Weekend Retreat.

Would you like to utilize childcare during the series?

YesNo

Primary Contact Information

First Name

Preferred Name (if different from First)

Last Name

Date of Birth (MM/DD/YYYY)

Mobile Phone

RTR will periodically text event information to this number

Mailing Street

City

State

Postal Code

Primary Role:

Base/Agency Name

Partner / Spouse Information

First Name

Preferred Name (if different from First)

Last Name

Date of Birth (MM/DD/YYYY)

Must be different than partner's email address

Mobile Phone

RTR will periodically text event information to this number.

Primary Role

Base/Agency Name

Childcare Needs

Number of Childcare Spots

Please note that childcare is available for ages 12 and under with a maximum of 3 children per family. Space is limited on a first-come-first-served basis.

Child 1 Name

Child 1 Age at Time of Retreat

Child 2 Name

Child 2 Age at Time of Retreat

Child 3 Name

Child 3 Age at Time of Retreat

Childcare notes:

Briefing

Prior to the event, you will engage in a short briefing (less than 15 minutes) to learn specific details about the program, eligibility, and final steps to secure your registration. Completing the briefing is required.

There are two options:

Pre-recorded Briefing Video: watch a pre-recorded video and confirm availability and eligibility by answering a short questionnaire.
Zoom Briefing with CEM: schedule a Zoom briefing with the Community Engagement Manager (this option is recommended if you have questions or concerns about the program that can't be answered by visiting the Responding to Relationships FAQ's on the website).

Your Briefing Option Choice

Pre-recorded Briefing VideoZoom Briefing with CEM

Additional Information

How did you hear about the Responding to Relationships Program?

Please tell us who:

Please tell us which one:

Please tell us which station:

Please tell us which platform:

Please tell us which agency:

Please describe:

Acknowledgement

YES, I understand that to register for the program, I must complete a briefing. I understand that by participating in the Responding to Relationships program and completing surveys, I may be eligible to receive up to $125 in incentives.

Please click "Submit" only once, as it may take a moment for your form to go through.

Contact Information