Oisterwijk, The Netherlands - aWALKening Retreat Registration:
November 11-13, 2016

Participant Registration Form

Thank you for signing up for the 3-day aWALKening to Personal Leadership Retreat in Oisterwijk, The Netherlands at the Boschoord Hotel this fall. Within a few days of completing and submitting this registration, you will receive an invoice. We will continue to be in touch with you leading up to the retreat in order to prepare you for this "moving" experience.

We look forward to meeting you and spending this special time together - Kate Link & Marijne van den Kieboom

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1. Contact Information - If more than one person is in the registering party, each must complete this form.

Name *

Address *

Address 2

City/Town *

State/Province (if from USA or Canada) *

ZIP/Postal Code *

Country *

Email Address *

Phone Number *

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2.
Select your choice of lodging - will be assigned first come, first served: (Note: Lodging includes 2 breakfasts, 2 lunches, 2 dinners and beverage service.) All rooms have two single beds - that can be pushed together.

Single Room - one person:
Individual Payment must be received by September 30, 2016: 650 Euros (tax is additional)
Individual Payment received after September 30, 2016: 720 Euros (tax is additional)

Corporate Payment must be received by September 30, 2016: 775 Euros (tax is additional)
Corporate Payment received after September 30, 2016: 845 Euros (tax is additional)

Shared Room - two people per room - indicate roommate below:
Individual Payment must be received by September 30, 2016: 575 Euros (tax is additional)
Individual Payment received after September 30, 2016: 645 Euros (tax is additional)

Corporate Payment must be received by September 30, 2016: 700 Euros (tax is additional)
Corporate Payment received after September 30, 2016: 770 Euros (tax is additional)

Commuter Rate - Includes the full program and all meals indicated, no lodging: (No reduction in cost if any meals are not needed - a "to go" option may be considered on a case-by-case basis.)
Individual Payment must be received by September 30, 2016: 450 Euros (tax is additional)
Individual Payment received after September 30, 2016: 520 Euros (tax is additional)

Corporate Payment must be received by September 30, 2016: 575 Euros (tax is additional)
Corporate Payment received after September 30, 2016: 645 Euros (tax is additional)

Indicate roommate's name: (Both parties must complete separate Registration Forms)

Payment: An invoice will be sent to you. Payment will be expected within two weeks of receipt.
Cancellation Policy: Payments made will be refunded in full (less a 50 Euro processing fee) if you cancel by September 30, 2016. If you cancel between October 1 and November 1, you will be charged 100 Euro cancelation fee. No refund is available if you cancel after November 2 or leave the program early. Emergencies may be considered on a case-by case-basis.

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3. List any special needs you require (e.g., dietary restrictions, lodging, etc.):

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4. Your experience with walking:

How often do you go for a walk?

How many miles or kilometers do you typically walk?

How many hours or minutes do you typically walk in a day?

What is the longest walk you have taken and when?

What was the most strenuous walk you have done and when?

What else would you like us to know about you and walking?

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5. What most interests you about the aWALKening Retreat? What do you hope to learn or experience?

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6. Would you like to be placed on the aWALKening (Leadership in Motion) mailing list? (We promise not to clutter your inbox.)

Yes

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7. How did you find out about the aWALKening Retreat?

Facebook posting

LinkedIn posting

Kate Link

Marijne van den Kieboom

Other (please specify)

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8. What questions do you have or what else would you like us to know about you?

By submitting this form you agree to the following:
1. I am in good physical condition and can walk a minimum of 4 miles or 6 kilometers in a day (broken into two walks with different paces accommodated) with potential for uphill walking. I do not suffer from any known disability or condition which would prevent or limit my participation in this aWALKening Retreat.

2. I understand that the aWALKening Retreat experience builds community. It is important to commit to attending sessions and participating in order to maintain the power and integrity of the community for myself and for others. I agree to be present when the group is convening and participate in aWALKening Retreat activities. (I recognize there will be designated time in the schedule for myself and non-Retreat activities of my own choosing.)

3. I agree to arrive by 13:30 on Friday, November 11 and stay until the aWALKening Retreat ends at 15:30 on Sunday, November 13, 2016.

4. I come to the aWALKening Retreat with curiosity and openness. I am interested in learning more about myself and understand that this might not always be what's most comfortable. I come ready to see myself and my life from new - or renewed - perspective(s).

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1. Contact Information - If more than one person is in the registering party, each must complete this form.

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2. Select your choice of lodging - will be assigned first come, first served: (Note: Lodging includes 2 breakfasts, 2 lunches, 2 dinners and beverage service.) All rooms have two single beds - that can be pushed together.

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3. List any special needs you require (e.g., dietary restrictions, lodging, etc.):

Question Title

4. Your experience with walking:

Question Title

5. What most interests you about the aWALKening Retreat? What do you hope to learn or experience?

Question Title

6. Would you like to be placed on the aWALKening (Leadership in Motion) mailing list? (We promise not to clutter your inbox.)

Question Title

7. How did you find out about the aWALKening Retreat?

Question Title

8. What questions do you have or what else would you like us to know about you?

2.
Select your choice of lodging - will be assigned first come, first served: (Note: Lodging includes 2 breakfasts, 2 lunches, 2 dinners and beverage service.) All rooms have two single beds - that can be pushed together.