Workshop and Retreat for Military and Responder CouplesOctober 13 & November 10-12, 2023

Workshop and Retreat for Military and Responder Couples
October 13 & November 10-12, 2023

IMPORTANT: Submitting this form does not guarantee your reservation. Events are high-demand, and space is limited to couples on a first-come, first-served basis.

Upon completion of the interest form, a Community Engagement Manager (CEM) will connect with you to schedule a 15-minute briefing to confirm your eligibility and talk about next steps.

Select the event date you would like to register for:

Kick Off Event: October 13, 2023 / Retreat: November 10-12, 2023 [CHILDCARE IS FULL]Future EventPlease select Future Event if you require childcare to attend.

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 Marriage Retreat.

Do you need childcare during the event?

YesNo

Primary Contact Information

First Name

Last Name

Mobile Phone

RTR will periodically text event information to this number

Mailing Street

City

State

Postal Code

Primary Role:

Base/Agency Name

Date of Birth

Partner / Spouse Information

First Name

Last Name

Must be different than partner's email address

Mobile Phone

RTR will periodically text event information to this number.

Primary Role

Base/Agency Name

Date of Birth

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:

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 a Community Engagement Manager will be reaching out to schedule a briefing within 72 hours to confirm eligibility and discuss next steps. 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