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PLAYA | Memoir Retreat Week Oct. 14-19
Please have each person in your party fill this out. If you have accessibility barriers please call Trina or Chelsea at 541.943.3983. Thanks for registering so we can better accommodate you.
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First Name
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Last Name
Your answer
Phone Number
Your answer
Email Address
Your answer
Full Address (e.g., 47531 Hwy 31, Summer Lake, OR 97640)
Your answer
Do you have accessibility needs? (i.e. ADA, no stairs, hearing impaired)
Your answer
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)
Other:
Who will you be sharing a cabin with?
Your answer
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
Other:
Emergency Contact Information (Name, Phone, Address, Email)
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