Northeast Retreat Registration Form
To complete registration for the Southeast Retreat in Dansville, NY (June 1-3), please complete all 3 steps. Fill out this form, sign + return the waiver, and submit your deposit at
Preferred name (first and last):
Please include area code.
Your home City, State:
List like this: Dallas, TX
Select which option applies to you and submit payment via Paypal to
STANDARD REGISTRATION: $100 deposit due by Feb 15 / $150 balance due by April 1
PAYMENT PLAN: $50 deposit due by Feb 1 / four additional $50 payments due by Feb 15, March 1, March 15, and April 1
Who is your D-Group Leader?
If you're the Leader, write your name here (first and last).
Is this your first D-Group Retreat?
No, I've been to 1 D-Group Retreat previously.
No, I've been to 2+ D-Group Retreats previously.
Do you have any food allergies?
If you answered yes above, please list food allergies here:
Gluten Free, Dairy Free, etc.
Regarding beds & sleeping, share with us below:
Please read ALL the options below and select the answers that apply. You can check more than one option.
I DO NOT have / cannot sleep on an air mattress or sleeping bag.
I have a SLEEPING BAG and am happy to use it (if necessary).
I have a TWIN air mattress and am happy to use it (if necessary).
I have a FULL air mattress and am happy to use it (if necessary).
I have a QUEEN air mattress and am happy to use it (if necessary).
I have a KING air mattress and am happy to use it (if necessary).
I don't mind sleeping on a COUCH if one is available / necessary.
I actually PREFER sleeping on alternative surfaces (floor, couch, sleeping bag, air mattress).
What size t-shirt do you wear?
Is there anything you want to share about your expectations, hopes, needs, or fears regarding this retreat?
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