Cedar Tree Healing Arts

1. Name *

First Name

Last Name

3. Phone *

(###)

###

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4. Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

7. Respecting Health Policy: Should you become ill before the retreat -- even if it feels like only a cold to you - you must let me know. I will cancel your registration and issue you a full refund. Should you become ill during the retreat, you must let me know, and I will issue you a partial refund. I have read and agree to this policy: *

Yes

No

8. Do you have any dietary restrictions? *

I am gluten free. It is a significant allergy/I have celiac disease and require a gluten-free kitchen

I strongly prefer gluten free foods but do not require a gluten-free kitchen

I am dairy free

I am vegetarian (no meat or fish)

None of the above - I eat everything!

Other

9. PAYMENT: There are multiple payment levels available, which cover food, facility rental, and tuition (not lodging). There are also a limited number of scholarships available. And Native/Indigenous students participate tuition free if desired. Please select the option that matches your level of financial resources, and remember that lodging costs will be billed separately. *

Basic Sustainer: I can pay the base fee of $450, which covers my own costs for the retreat.

Supporter: I can pay the fee of $550, which supports a person with limited income to participate.

Supported: I can pay the low income fee of $325.

Scholarship: I need to pay an amount lower than $325 (please be sure to answer the final question on this form)

Native/Indigenous: I accept your offer of free tuition and facility rental, and will pay only for my lunches and dinners: $72. If I choose to stay at Deer Hill, I will also pay my lodging costs. I understand I will be billed for these costs later.

Gold Sponsor: In addition to my own retreat fee, I would like to provide a full scholarship for another participant, totaling $900 for both of us. I understand that my gift will remain anonymous to support an experience of equity at the retreat.

I am traveling from out of town and wish to lodge Thursday night as well. I will pay for an extra night, and understand that I am responsible for providing my own breakfast on Friday morning. *

Yes

No

FOR THOSE WHO HAVE CHOSEN ROOMS ONLY: Would you like to share your room with a roomate?

Yes

No