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Registration Intake Form // Emotional Graffiti at Pinecrest Northwoods Lodge
Event Dates: Sunday, August 13 - Wednesday, August 16, 2023
Event Address: 12199 Pinecrest Lane, Republic, Michigan 49879 ~ Some GPS maps read this address as Champion, Michigan
Contact us at (906) 398-1612 or
h
ello@apiarylifestudio.com
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Participant Name
*
Your answer
Participant Phone Number
*
Your answer
Participant Email
*
Your answer
Participant Address
*
Your answer
Are you sharing your lodging (bed, tent, or cabin) with another participant?
*
No
Yes
If you selected "Yes" to sharing your lodging (bed, tent, or cabin) with another participant, PLEASE LIST THE NAME OF THE PERSON YOU ARE SHARING LODGING WITH HERE SO THAT WE MAY PROPERLY MATCH YOUR REGISTRATIONS:
Your answer
Dietary restrictions
*
None
Vegetarian
Vegan
Gluten-free
Other:
The $500 deposit requirement plus submission of this completed Registration Intake Form provides an
initial reservation
of my spot
for this experience.
I understand that my retreat package must be paid in full by August 5, 2023 to participate in this retreat.
*
Yes
Required
I understand that I will be contacted by a retreat team member by phone and/or email within 36 hours of their receipt of both my $500 package deposit AND this completed Registration Intake Form to confirm my registration reservation. I will make a payment plan for the remaining amount due on my retreat package at that time.
*
Yes
Required
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