EYE Retreat Reunion Celebration
The EYE Retreat is celebrating 15 years of service!  We are honored that you previously attended the EYE Retreat. We wish to invite you for a Reunion of all EYE Retreat participants, mentors, and volunteers.  

The Reunion will be held from 2pm to 7pm in Carolina Beach, NC.  While in Carolina Beach, you can enjoy time on the beach, walk along the boardwalk, ride amusement park rides, or visit NC Aquarium or Fort Fisher Historic with your other friends attending the Reunion.  

The EYE Retreat will provide transportation to and from Raleigh to Carolina Beach.  On-demand transportation on the island is available through Ride Micro.  

We plan to host a dance and dinner to end the Reunion that night.  

You may arrive early on Friday, August 4 to attend the Reunion and we will provide housing at Governor Morehead School.  You may also stay on campus the night of Saturday, August 5.  Everyone must leave on Sunday, August 6.  

Registration for the Reunion will close on May 31.  

Thank you,

Dr. Alan Chase
President and Director


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Name (first and last) *
Full Mailing Address (street, city, state, and zip code) *
What is your email address? *
What is your cell phone number? *
How old are you? *
I will need housing at Governor Morehead School on these nights: *
Required
While in Carolina Beach, I think i would be interested in these activities:  *
Required
i will need transportation from Raleigh to Carolina Beach and back. *
Gender: *
My t-shirt size is: *
Do you have any medical conditions besides blindness (be specific)? *
Do you have any food allergies or restrictions (be specific)? *
Do you take any medications (be specific)? *
Do you require any other accommodations to participate (be specific)? *
Please provide contact information for a friend or family member in the event of an emergency. *
Name, phone number(s), and relationship to you.
Please describe here if you have ever been charged with a crime, convicted of a crime, suspended or expelled from work or school, asked to resign from a position, or been disciplined for violating established policies. *
If none of the above apply to you write "not applicable" below.  If any of the above applies to you, please describe the circumstances surrounding the incident.  Please note that disclosure of any of the above items does not automatically exclude you from being part of the EYE Retreat.
I have requested all reasonable accommodations on this form and have disclosed any and all medical conditions.  I understand that by not disclosing medical conditions or requesting accommodations in a timely manner, the EYE Retreat may not be able to accommodate my specific needs. *

I understand that failure to honor my commitment may result in hardship for the EYE Retreat as the result of my actions.  If you are unable to attend the EYE Retreat Reunion, you must notify Dr. Chase in writing at alan.chase@eyeretreat.org by June 15, 2023.  If I do not attend the EYE Retreat Reunion in its entirety or fail to notify Dr. Chase of changes of my plans by the deadline, I promise to reimburse the EYE Retreat the amount of $327.00.   *
I promise to honor my commitment, check and use  email for communication frequently, and fulfill my duties and responsibilities as outlined in all EYE Retreat policies, procedures, and practices found at www.eyeretreat.org.   *
Is all the information you have provided on this form true and accurate? *
Print YOUR name here indicating you are submitting this form with true and accurate information. *
Parent/Guardian print YOUR name here if participant applicant is under the age of 18 indicating your are submitting this form with true and accurate information and that you give permission for your son/daughter to submit this application.
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