People of Color Retreat (6 days) - POC

June 20 – 26, 2014 (Friday to Thursday)

Complete the information requested below, then click the "Submit Registration" button at the bottom of the form. Once your registration is submitted, you will receive a Confirmation Code — please quote this in any future correspondence. Within a week, you should receive further information from us regarding your registration status.

Retreatant Information

First Name
Last Name
Middle Initial
Zip/Postal Code
Day Phone
Evening Phone
Cell Phone

Retreat Fees

Sliding scale rate you select:
Sustaining $730.   (This represents IMS's actual cost for this program.)
Mid $575
You Choose $ (Please be as generous as you can if selecting this option so that IMS can offer this form of financial assistance to as many as possible. A minimum of $15 per day is required.)
Amount you will pay today:
Sustaining $730
Mid $575
You Choose $ (The deposit is the minimum required) .
Deposit $90

Retreat Center Questions

Male Female  
Yes No
Yes No
Yes No
Yes No

Mailing Information

Yes No
Yes No
Yes No
Yes No
Yes No
Yes No

Payment Information

Note: Address below must match what is on file with your credit card company or the transaction will be declined.

Visa Mastercard

Additional Donation

I would like to contribute an additional amount to IMS.

I have read the registration information and cancellation policy. Click here to review.

Please submit your registration. Provided you have answered all the questions, a Confirmation Code should immediately appear on your screen. If no code number appears, your application did not go through. Please check that you have completed the form correctly and disabled all script blockers, and submit it again. If you have any questions, contact the Retreat Center by calling 978-355-4378 or emailing

Online Payment Service