Center for Sacred Sciences

***RESIDENTIAL REGISTRATION IS CLOSED***
***ZOOM REGISTRATION IS STILL OPEN***
Know Thyself
A seven-day retreat led by Todd Corbett
Know Thyself
A seven-day retreat led by Todd Corbett
November 10-17, 2024
Alton L. Collins Retreat Center, Eagle Creek, Oregon

Note: Only current CSS members may register for retreats.

PLEASE FOLLOW THESE INSTRUCTIONS:
1. Fill out this form from top to bottom.
2. Enter amounts as numerals (e.g., '50' not 'fifty').
3. Click the 'calculate' buttons as you go.
4. Any item marked with (*) can not be left blank.
5. Click the Submit button at the bottom when finished.
6. You will get an email message with your information and payment instructions in it.
7. Mail your payment to CSS to complete your registration.

RETREAT FEES

ONLY ZOOM OPTION IS AVAILABLE AT THIS TIME. Will you be attending the retreat in person at the retreat center or remotely via Zoom? Note: The Zoom option is restricted to people unable to attend in person. Only select Zoom if it is not possible for you to attend in person.*

In person at Collins Retreat CenterRemotely via Zoom You must select an option.

Please select your residential retreat fee. If it is a financial burden for you to pay the basic fee, select reduced fee to request a scholarship to cover the remaining amount.*

$1325 - Supporting fee$1225 - Basic feeReduced fee (enter below) This field is required

Please explain why it is not possible for you to attend the retreat in person.*

This field is required

Please select your Zoom attendance fee. If it is a financial burden for you to pay the basic fee, select reduced fee to request a scholarship to cover the remaining amount.

$530 - Supporting fee$490 - Basic feeReduced fee (enter below) Invalid Input

I can afford to pay the reduced fee that I have entered here, and I am requesting a scholarship for the remaining balance.*

please enter a dollar amount as numerical digits.

DONATION

The CSS retreat scholarship fund helps practitioners in financial need attend CSS retreats. Enter the amount you are donating (which must be paid when registering).

please enter a dollar amount as numerical digits.

Optional Donation to Collins Retreat Center

please enter a dollar amount as numerical digits.

RETREATANT INFORMATION

First Name*

Please provide your first name.

Last Name*

Please provide your last name.

Your Email - Please double-check that your email address is correct! You will not receive a confirmation of registration if your email address is not correct. *

Please provide your email address and make sure it is valid.

Your Phone Number:*

Please provide your phone number.

Street Address:*

This field is required.

City:*

This field is required.

State:*

This field is required.

Zip / postal code:*

This field is required.

Country:

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Would you like to participate in ride sharing to/from the retreat?*

Yes, I can drive and give a ride to someone
Yes, I would like a ride from someone else
No This field is required.

Please indicate if you have any special transportation plans or needs:

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Please describe any physical limitations, or health/medical issues that CSS or Collins staff should know about:

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Health care provider, in case of a health emergency during the retreat:*

Please provide the name of your healthcare provider.

Phone number of heathcare provider named above*

Please provide the phone number of your healthcare provider.

Emergency Contact: Name of spouse, close friend, or family member we should contact in case of an emergency during the retreat :*

Please provide the name of your emergency contact.

Phone number of emergency contact named above*

Please provide the phone number of your emergency contact.

DIETARY QUESTIONS

We strive to serve healthy and delicious food. We do this by providing you with meals made on site that are non-GMO, local and organic whenever possible. Our kitchen focuses on utilizing whole foods, featuring vegetables, fruits, grains, beans, meats, vegetable proteins and dairy.

Do you have any specific dietary requests or restrictions?*

YesNo This field is required

What are your specific dietary requests/restrictions? If you make exceptions in your diet category (for example, you are generally dairy-free but you can eat ice cream) please let us know. We strive to meet all dietary needs of our guests as part of our ministry of hospitality.

Gluten-freeDairy-freeVeganVegetarian (eats eggs and dairy)Pescatarian (fish but not mammals or birds)No red meat (no beef, pork, lamb)Kosher meats only (meat will not be blessed but is on the approved list)Other allergies or sensitivites (please explain below) Invalid Input

Do you eat honey?*

YesNo This field is required

Do you eat butter?*

YesNo This field is required

Do you eat sheep or goat dairy?*

YesNo This field is required

Please note that we do not have emergency treatment for life threatening allergies on site. You may contact our office (503-637-6411) to discuss emergency medical treatment possibilities.

Do you have an airborne allergy?*

YesNo This field is required

Description of airborne allergy. What do you have an airborne allergy to? What levels of precaution are needed?*

This field is required

Please indicate your specific allergies or sensitivities*

We consider the following to be tree nuts: almonds, brazil nuts, cashews, chestnuts, filberts/hazelnuts, macadamia nuts, pecans, pistachios, pine nuts, shea nuts, walnuts.*

I cannot eat any of these nutsI cannot eat some of those nuts (specified below)I also cannot eat the additional nuts (specified below) This field is required

I cannot eat the following tree nuts

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Expanded description of any specific dietary requests:

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OPTIONAL QUESTION: Are there any foods you do not like to eat?

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OPTIONAL QUESTION: What kind of cuisines do you prefer?

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Other considerations. Please let us know if you have any special needs that we should be aware of. Indicate below if there is anything else we need to know in order to prepare for your arrival--for instance, you use a wheelchair, or you need to bring medical equipment with you. It is easier for us to accommodate your needs if we know in advance. Thank you!

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Collins Retreat Center sends out periodic communications regarding Center updates, volunteer opportunities, and other ways to stay connected.

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Please carefully review all the information above, make sure all items marked with * have been completed, then click the Submit button below. After you click the Submit button below, you should see a confirmation page. If you are returned to this form instead, there was a problem with the form, and you need to review all your information and try again.

Before you submit this form, you must click the box.*

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By clicking Submit, you are making a commitment to attend this entire retreat, and you understand and accept the CSS retreat fee refund policy.

Retreat Registration