Registration Form: REACT Chicago Retreat 2019

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Join us to an Inspirational, Enriching, Alcohol-Free, and Kids Welcome Event at Ronora Lodge and Retreat Center, 9325 Dwight Boyer Road, Watervliet, MI 49098. October 5 and 6, 2019 (Rain or Shine)

For each participant to be in the program, they are kindly requested to read below carefully and fill out this registration form. PLEASE PRINT CLEARLY.

This retreat program is organized by the Reiyukai America Chicago Activity Committee and Reiyukai America office with the purpose of raising awareness of the importance of becoming a leader in the community while deepening the understanding of the teachings of Reiyukai. Each participant is reminded to be aware beforehand that there is a fee in order to be part of the retreat program.

The fees are: $50 for a participant 18 and older for a 2 days 1 night stay including three meals, facility fee, transportation fee, and an individual bed. $15 for participants 7-17 years old / $5 for participant 0-6 years old, under the same conditions mentioned above. The early bird registration will be until September 30th. Starting October 1st, the fees will increase as follows: $50 to $60, $15 to $20, $5 to $8. Your reservation will not be completed until you pay in full by October 3rd, 2019. Reservations accepted on a first come, first served basis. Participants 17 years and under needs to be registered in one of the applications that is filled by their parent/guardian.

If a participant cannot attend the two days, there is an option to attend the first day for $30 including two meals and facility fee, however it is very important for the “one-day- participant” to know Reiyukai America will not be responsible for accommodating transportation for return to the point of origin.

A participant has an option to use his/her personal vehicle to attend the retreat by releasing Reiyukai America and its designated representatives from a liability due to any accident or damage that may occur to the vehicle while transferring to/from the retreat center and during the retreat.

As a method of payment, Reiyukai America accepts checks and credit cards. For checks, please make check payable to Reiyukai America. For credit cards, please call 626.356.8055. If you need to cancel your reservation, please contact Reiyukai America office by October 3rd for a full refund. Otherwise, your fee will not be refunded.

Email *

Name of Participant and DOB *

Please provide Emergency Contact Information: (Name, number, relationship) *

For parents planning to attend with child/children, please provide the following: Name, Age, Relationship

I am (We are) attending... *

Both October 5 and 6 in full

Only October 5 and I am aware that I am responsible for my own transportation for return.

I will make my payment via

Check or Cash at the Retreat

Online Payment http://www.reiyukai-usa.org/archives/2208

Clear selection

Point of Gathering. Please select one from the following *

North Chicago -- Isla Filipina Parking Lot (2501 W Lawrence Ave, Chicago, IL 60625)

South Chicago -- Pilsen Wellness Center Parking Lot (2319 S Damen Ave, Chicago, IL 60608)

Ronora Lodge and Retreat Center (9325 Dwight Boyer Road, Watervliet, MI 49098)

Disclaimer of Liability (Please check each box) *

Reiyukai America, as the organizer of REACT Chicago Retreat 2019, held on 5 and 6 of October 2019 at Ronora Lodge and Retreat Center, reserves the right to make changes and alterations to this event as necessary for safety, and proper handling of the program.

Outdoor activities of this nature are not entirely "risk free." Reiyukai America is not responsible for injury or death to participants, damage or loss to personal belongings, or for punitive damages. Reiyukai America and the organizers of the Retreat program are not responsible for cost of delays resulting from weather, road construction, road traffic, or any unforeseen circumstances.

REACT Chicago Retreat 2019 is an alcohol free program. Participants are not allowed to consume alcoholic beverages during the retreat.

Participant agrees there will be a photographer taking pictures during the event for the record of Reiyukai America as well as publication purposes.

Participants who choose to drive his/her own vehicle releases Reiyukai America and its designated representatives from a liability due to any accident or damage that may occur to the vehicle while transferring to/from the retreat center and during the retreat.

The undersigned has read carefully the Disclaimer of Liability above and accepts any risk associated with the retreat program. The participant forfeits all rights to bring a suit against Reiyukai America in regards to the retreat program for any reason.

The undersigned will also agree to follow the instruction given Reiyukai America in any case of emergency.

Required

By typing my name below, I certify that I have read, reviewed, understood all of the details mentioned above, and all the information that I provide is correct. *

For parents participating with his/her child/children: As a parent of my child/children, I certify that I have read, reviewed, understood all of the details mentioned above. I also agree, by typing my name below, the above disclaimer of liability will be applied for my child/children. I agree in fulfilling all the rules and requirements mentioned in this registration form. *

A copy of your responses will be emailed to the address you provided.

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