Personal Details

1. Full Name:

2. Age:

3. GSM/Mobile Phone Number:

4. Email:

5. Do you have any physical condition/handicap that may prevent your participation in physical activities and/or climbing stairs?
 Yes No

- If yes, please specify – if you are comfortable (this information will be treated confidentially):

Registration Fee

1. I can pledge the following amount to the retreat cost:
 20€ (for the deposit) 30€ 40€ 50€ 60€ 70€ (full amount) other*If Other please specify amount:

2. I would like to apply for a sponsorship to attend the retreat:  Yes No

3. I hereby commit to honor my intention to attend the retreat, as well as to follow through on my financial pledge, as best I can:
 Yes No
*(If you feel led, you may donate an additional amount to provide assistance for someone else to attend…please indicate this in the “other” option:)

Logistics

1. Can you come in your own car?
 Yes No

2. Can you travel in the group convoy (departing from De Stroming at 19:00, on 22 September)?
 Yes No
- If no, when can you depart?
 Friday (22 September) evening after 19:00. Saturday morning (23 September).

3. Do you plan on leaving the retreat early for any reason?
 Yes No
- If yes, when & at what time?

Food

1. Do you have any food allergies/preferences?
 Yes No
- If yes, please explain:

- If yes, do you prefer providing your own meals?
 Yes No

Volunteer!

1. I can provide a seat(s) in my car!  Yes No
Please specify amount:

2. I can help with meal preparation, cleanup and general setup of venues:  Yes No

3. I can help with setup/planning of recreational activities:  Yes No