Center for Sacred Sciences

Awakening from Delusion
A five-day silent residential retreat led by Todd Corbett, assisted by Mora Fields
May 6-11, 2020
Alton Collins Retreat Center, Eagle Creek, OR

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 in it.
7. Mail your payment to CSS to complete your registration.

ATTENDANCE

Will you attend the entire retreat or just part of it? Priority is given to people registering for the entire retreat.*

Entire retreat - Supporting Fee ($900)

Entire retreat - Basic Fee ($785)

Part of the retreat ($185/day, stand-by registration)

Please make a selection above

Enter the number of nights you will be on retreat as a numerical digit (1-9).*

Please enter the number of nights on retreat as a numerical digit (1-9).

Arrival Date*

Date must be entered in mm/dd/yyyy format

Arrival Time*

First meal on arrival date*

Breakfast

Lunch

Dinner

Not sure yet - I'll let you know asap

Please indicate first retreat meal.

Departure Date*

Date must be entered in mm/dd/yyyy format

Departure Time*

Last meal on departure date*

Breakfast

Lunch

Dinner

Not sure yet - I'll let you know asap

Please indicate last retreat meal.

Since you are attending just part of the retreat, please indicate any special transportation plans or needs:

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Total Retreat Fees*

Click the calculate button to set this value

SCHOLARSHIP REQUEST

Do you need a scholarship? (If paying the full retreat fee is a financial burden, you may request a scholarship for a portion of the fees.)*

No, I do not need a scholarship.

Yes, I need a scholarship.

Please make a selection

Enter the amount of the total retreat fees that you can afford to pay. Our scholarship fund is limited. Please pay as much as your are able.

Please enter a dollar amount, as numerical digits.

DONATION TO SCHOLARSHIP FUND

The retreat scholarship fund helps practitioners in financial need attend CSS retreats. Enter the amount you are donating (which must be paid when registering). Enter 0 if you are not making a donation.

please enter a dollar amount as numerical digits.

TOTAL FEES DUE

Total less donation

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Grand total amount due, after adjustments (if any) for scholarship.*

Click the calculate button to set this value

PAYMENTS

How much of the grand total due will you pay now? A $100 deposit plus any donation you are making must be paid now (unless your scholarship includes the deposit).*

Please enter an amount using numeric digits.

This remaining amount must be received by the payment deadline date in order to ensure your place at this retreat.*

Click the calculate button to set this value

RETREATANT INFORMATION

Full Name*

Please provide your 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:

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City, State, Zip:

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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.

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.

Please describe any food allergies, physical limitations, or health/medical issues that we should know about:

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If you would like to participate in ride sharing to/from the retreat, please select:

I can drive and give a ride to someone
I would like a ride from someone else
None of above Invalid Input

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

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Special needs or requests, or any concerns or questions for the retreat coordinator:

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

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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. After you submit this form, you will need to complete the Guest Information Form for Collins Retreat Center in order to specify any dietary requirements.

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

Retreat Registration