Wellness Is Elemental Registration

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First & Last Name *

Email *

Telephone

Dietary needs & considerations

Physical needs & considerations

Emergency contact Name & Phone number *

Room preference *

I'd like to share a DOUBLE occupancy room with a friend who also is attending

I'd like to make a new friend in a DOUBLE occupancy room

I prefer to zen in solitude in a SINGLE occupancy room

Names of friends intending to join you

I intend to make payments as follows: *

I understand and agree to the following by selecting the date of my agreement: Itinerary details may be adjusted to accommodate changes to vendor schedules and offerings. A deposit of $100 guarantees you a spot at the current rate and is refundable up until 15 March 2020. After 15 March 2020 this deposit is not refundable Balance is due in full by 15 July 2020. This balance is refundable up until 15 July 2020; thereafter it is non-refundable.If for any reason Siren School is regretfully forced to cancel the event, all funds paid will be refunded in full. In such case, if you've made travel arrangements, consult your travel insurance policy for coverage details. *

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Typing my name below serves as my digital signature and commitment to all the above *

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