Rolling Ridge Program Event Proposal

*First Name
*Last Name
*Address 1
*Address 2
Descriptive Title for Event
*Type of Event
Day Apart Retreat (one day retreat from 9:30am-3:30pm)
Overnight or weekend tretreat
Week-long retreat
If other, please specify
Please identify the area(s) of your topic for this event
Health and Wellness
Peace and Justice
Creation & Environment
If other, please explain
In two paragraphs, describe your Day Apart Program (we may use this for promotion)
We hope all Rolling Ridge events will weave together input and reflection for a holistic experience. Please estimate an approximation of the percentage of time needed for:
Presentation/Teaching %
Large group conversation %
Experiential %
Small Group Sharing %
Individual Reflection %
*Please provide a couple of sentences about yourself and describe briefly your background and experience with this topic. If we don't already have one, please email a headshot which can be used for publicity to
*Please provide the name and email address for two people who would be able to provide reference for you as a retreat leader.

First reference

*2nd reference
Upload your photo to be used in promotions

Attach file pdf, doc(x), xls(x), jpg/gif/png, ppt - up to 25 MB

Please include a brief bio to be used in promotions max length 600 characters
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