Online Registration
All information entered will be held confidential, only accessible by the co-chairs strictly for the registration process and deleted immediately following the retreat.

Registration will close on Friday, August 3, 2018 at 10 p.m. CST.

First Name *
Your answer
Last Name (or initial) *
Your answer
Email *
Your answer
Phone *
Your answer
Are you in need of a scholarship?
Limited scholarship funds are available. Please indicate below if you are in need of a scholarship and contact a co-chair ASAP at mailroom@slaa.org or 312-725-9918.
Payment Options *
Retreat cost = $198 (includes 2 nights, 6 meals and private bed and bathroom). If you are in need of a scholarship, a minimum payment of $100 is suggested.
Total Payment To Submit *
Please add retreat cost ($198) and any optional donation to the scholarship fund. If you are in need of a scholarship, a minimum payment of $100 is suggested. Final scholarship amounts will be awarded once donations have been received.
Your answer
Do you require vegan, vegetarian or gluten-free meals? *
Please choose all that apply.
Required
Do you need a ride?
Can you provide a ride to another attendee?
Are you available to be of service?
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms