2026 HIV Retreat at Shadowcliff Survey

NAME(Required.)

First Name:

Last Name:

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

E-MAIL & PHONE(Required.)

E-mail:

Cell phone:

ADDRESS(Required.)

Address:

City:

State:

Zip Code:

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).(Required.)

Name:

Relationship:

Best phone that weekend:

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).(Required.)

I need a ride

I can drive and take passengers

I am flexible to ride -OR- drive

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

If you can drive and take passengers, how many persons can you take in addition to yourself:

RETREAT FEE

Lodging, meals, and activities cost over $355 per person for us to provide, however ..........

All HIV+ can request an optional $50 fee reduction.
HIV+ Individuals on disability or very low income can apply for additional assistance up to $215 (reducing the fee to as low as $90).
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:(Required.)

Yes

I would like to apply for additional financial assistance:

Yes

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

Have you attended the retreat in the last 10 years (2016 or later)?(Required.)

Yes

If yes, how many times?

Once

2-3 times

4 or more times

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

AGREEMENT/UNDERSTANDING

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

Yes

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(Required.)

Yes

Entering my name and date below constitutes my signature

(Required.)

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!

2026 HIV Retreat at Shadowcliff

13-16 August 2026