Wufoo

CHASA Retreat Updates

You're signing up to receive CHASA Retreat updates. Our next National Family Retreat will be in the summer of 2018. We'll let you know when and where. Hope to see you there!

We'll send updates using email, so please make sure you can receive mail from our address. We'll provide that after you submit the form.

The information you supply below will only be shared with the CHASA staff. We never sell or share information with other organizations or businesses. Your contact information will help us determine where to host future retreats.

Name * First Last
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *
Phone Number * ### - ### - ####
Age of your child or if you're an adult with hemiplegia - just write "adult with hemiplegia" and supply your age or approximate age *
Address of your personal Facebook page (optional)
If you're familiar with a hotel that has: two different spaces or a combination of space for 800, a large pool, is within 2 hours of a major airport, and is under $250 a night for a sleeping room, please share this information with us. We're always looking for new retreat locations!
Questions or Comments
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