Registration - Step 1

Program Information

You are registering for:

Program:: Writing as a Pathway Through Grief, Loss, Uncertainty and Change
Dates:: August 1-7

The housing prices below are the total charges for lodging, meals, and use of the facilities.

Have you gotten a confirmation that your application from Laura and Evelyn that your application has been approved? Please make sure you have that before you arrange your housing with Mount Madonna.

Registrant Information

* First Name:
* Last Name:
Alternate Name:

* Gender Identity
(for housing purposes):

Woman
Man
Transgender
Non-binary/non-conforming
Prefer not to respond
How does my choice affect my housing?

* Preferred Pronouns:
Why pronouns matter
* Street Line 1:
Street Line 2:
* City:
* State/Province:
* Zip/Postal Code:
Country: Defaults to USA
* Telephone:
* Email:
* Email Again: Repeated to be sure it is right
Car License: If you are driving to MMC.

Housing Choice

Indicate your first and second choices for housing.
We will do our best to honor your choices. If neither is available, we will assign the next best option, and waitlist you.
Prices are the total charge including meals, lodging, and use of facilities.
Camp sites are walk-in style with parking nearby.
If you have a physical disability that limits where you can be housed, please note this in “Additional Requests” below.
All individuals must be registered separately.

1st	2nd	Housing	Cost
		Single w/ Bath	$1658
		Single	$1340
		Double w/ Bath	$1214
		Single in Cabin	$1166
		Double	$1028
		Double in Cabin	$980
		Triple	$836
		Own Van	$542
		Own Tent	$542

If you are sharing your housing with someone, put their name here:

First Make sure that they register separately.
Last

If given a choice, would you prefer a cabin or a room?
What's the difference?

Cabin - heat and electricity, but no indoor plumbing
Room

Gift Card

Gift Card code for Payment

Dietary Restrictions

Please note any dietary restrictions you have such as vegan, gluten free, allergies, etc:

Additional Requests

Include the following in your additional requests:

Arrival and/or departure dates if they differ from your program's.

Important Notes

This program is for adults only - please do not bring your children.
Cancellations made at least 2 weeks before your reservation date are fully refundable. Cancellations made 2 weeks to 48 hours prior to arrival date will be charged a $50 processing fee and the remaining payment will be held as a credit toward a future personal retreat or program. There are no refunds for cancellations made less than 48 hours prior to your reservation date.
This form does not automatically reserve your spot for the program. If the program is full, your deposit will be refunded.
Housing is not always available. Do not finalize your travel plans until you have received a housing confirmation from Mount Madonna Center.
We will be sending you a confirmation email. Don't let it end up in your spam folder. Add the following addresses to your list of acceptable emails: programs@mountmadonna.org.