2024 HIV Retreat at Shadowcliff

18-21 July 2024

Please complete one registration form for each person attending.
After you register, you will get a phone call just to touch base on your registration, and later on a confirmation letter with more information about the retreat and fee payment

If you have any questions, please feel free to contact Michael at:
retreat.shadowcliff@gmail.com
or 303.777.5737

Thank you!

Question Title

NAME

First Name:

Last Name:

"Common" First Name used by friends (for name tag):

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E-MAIL & PHONE

E-mail:

Cell phone:

Land line phone (skip if you don't have one):

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ADDRESS

Address:

City:

State:

Zip Code:

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EMERGENCY CONTACT INFORMATION
This cannot be someone attending the retreat with you.
Note: The contact needs to be available by phone the weekend of the retreat
(please do not list Monday-Friday work phones).

Name:

Relationship:

Best phone that weekend:

Question Title

CARPOOL
We organize a carpool and encourage everyone to participate. This not only assists those without cars, but also has less impact on the environment, and parking space is limited at the lodge. We meet at 10am near Broadway & Alameda on Thursday morning. The trip is 100 miles and takes 2 hours.
We ask that riders offer gas money to their driver ($6-8).

I need a ride

I can provide transportation

I am flexible to ride OR drive

I will go on my own (but MAY be able to take someone if really needed)

If providing transportation, how many persons can you take in addition to yourself:

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DIETARY NEEDS

I am vegetarian.

I am vegan.

I cannot eat wheat/gluten.

I have other dietary issues (please explain):

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RETREAT FEE
Lodging, meals, and activities cost $300 per person for us to provide, however ..........

All HIV+ can receive an optional $50 fee reduction.

HIV+ Individuals on disability or low income can apply for additional assistance up to $170 (reducing the fee to as low as $80).

The fee is all inclusive and covers 3 days lodging & meals, body therapies, and all activities.

A five dollar lodge staff gratuity will be added to the fee; and carpool riders are asked to contribute gas money to their driver ($6-8).

Note: Assistance is limited to residents of Colorado and adjoining states (WY, NM, NE, KS, UT) unless there are special circumstances.

I understand the fee structure:

Yes

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Please email me a Financial Assistance Application:

Yes

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Briefly please state why you would like to attend the retreat (a few sentences is fine):

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Have you attended the retreat in the last 10 years (2014 or later)?

Yes

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If yes, how many times?

Once

2-3 times

4 or more times

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To the best of your knowledge, which years did you attend (best guess if you can't remember):

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AGREEMENT/UNDERSTANDING

I understand and agree to abide by the ground rules of no smoking on the property, no alcohol, marijuana (smoked or edible), or illegal drugs (on or off property, including bars in town), and no inappropriate behavior.
verified by my signature below

Yes

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I acknowledge that this is an organized HIV retreat and that I intend to participate in retreat activities including workshops, forums, meals, and other group activities.
verified by my signature below

Yes

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Entering my name and date below constitutes my signature

Signature:

Date:

When you have completed this form, please check it for accuracy.
Then click "Submit Registration" button below.

Thank you for registering online.

Looking forward to the retreat!

Question Title

NAME

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E-MAIL & PHONE

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ADDRESS

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EMERGENCY CONTACT INFORMATIONThis cannot be someone attending the retreat with you.Note: The contact needs to be available by phone the weekend of the retreat(please do not list Monday-Friday work phones).

Question Title

Question Title

DIETARY NEEDS

Question Title

Question Title

Please email me a Financial Assistance Application:

Question Title

Briefly please state why you would like to attend the retreat (a few sentences is fine):

Question Title

Have you attended the retreat in the last 10 years (2014 or later)?

Question Title

If yes, how many times?

Question Title

To the best of your knowledge, which years did you attend (best guess if you can't remember):

Question Title

AGREEMENT/UNDERSTANDINGI understand and agree to abide by the ground rules of no smoking on the property, no alcohol, marijuana (smoked or edible), or illegal drugs (on or off property, including bars in town), and no inappropriate behavior.verified by my signature below

Question Title

I acknowledge that this is an organized HIV retreat and that I intend to participate in retreat activities including workshops, forums, meals, and other group activities.verified by my signature below

Question Title

Entering my name and date below constitutes my signature

EMERGENCY CONTACT INFORMATION
This cannot be someone attending the retreat with you.
Note: The contact needs to be available by phone the weekend of the retreat
(please do not list Monday-Friday work phones).

AGREEMENT/UNDERSTANDING

I understand and agree to abide by the ground rules of no smoking on the property, no alcohol, marijuana (smoked or edible), or illegal drugs (on or off property, including bars in town), and no inappropriate behavior.
verified by my signature below

I acknowledge that this is an organized HIV retreat and that I intend to participate in retreat activities including workshops, forums, meals, and other group activities.
verified by my signature below