PLAYA | Modern Love Weekend Oct. 11-13

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Thanks for registering so we can better accommodate you. Please have each person in your party fill this out. If you have accessibility barriers please call Trina or Chelsea at 541.943.3983.

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First Name

Last Name

Phone Number

Email Address

Full Address (e.g., 47531 Hwy 31, Summer Lake, OR 97640)

Do you have accessibility needs? (i.e. ADA, no stairs, hearing impaired)

Sleeping Arrangements - Most cabins have one queen sized bed.

Single person

Single person willing to share a cabin

Couple that will share a bed

Requesting two beds - double occupancy (we have one cabin with two beds)

Outro:

Who will you be sharing a cabin with?

Dietary Information: If food is being prepared for you at Playa. Please mark if you have a life-threatening, severe food allergy.

I have no dietary restrictions

Vegan

Vegetarian

Gluten Free

Dairy Free

Egg Allergy

Shellfish/Seafood Allergy

Tree nut allergy, which type? please add to "other" below

Outro:

Emergency Contact Information (Name, Phone, Address, Email)

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