Registration - Step 1

Program Information

[% IF pr %] You are registering for a Personal Retreat.
$pr_dates [% IF outdoors %]

Outdoor housing only. [% END %] [% IF no_center_tents %]

Center tents are not available. [% END %]
[% ELSE %] You are registering for:
[% IF two_pics %] [% ELSIF one_pic %] [% END %]
Program:
$title
Dates:
$dates
[% IF leader_names %]
Presenter:
$leader_names
[% END %]
[% END %]
[% IF pr %] [% END %] [% IF basicfull %]
Length of Program

*How many days do you want to attend?

[% ELSE %] [% END %]

Registrant Information

  1. Defaults to First Name

* Gender:



  1. Defaults to USA
  2. Repeated to be sure it is right
  3. If you are driving to MMC.
[% IF ceu %]

Continuing Education Credits

If you are a nurse[% IF mft %], LMFT, or LCSW[% END %] and wish to receive a CEU certificate

Like this: RN98765[% IF mft %], MFT43210 or LSW31415[% END %].
If you only want a certificate of completion enter COMP for the license #.
[% END %] [% IF ! housing_not_needed %]

Housing Choice

$dncc_why [% IF ! do_not_compute_costs %] [% IF basicfull %] [% ELSIF next_hc %] [% ELSE %] [% END %] [% END %] $housing_fees
1st 2nd HousingCost for
$bdays days
Cost for
$fdays days
Cost
through
$through_date
Cost on
and after
$next_date
Cost

If you have a physical disability that limits where you can be housed, please note this in “Additional Requests” below.

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

If you wish to share your housing with someone, put their name here:

  1. Make sure that they register separately.
[% END %]

Preferences

[% IF ! pr %]

Carpooling

  1. Privacy Concerns?
[% END %]

How did you first hear about this program?

Shall we keep you informed of events at Mount Madonna Center?

  1. Would you like to contribute to our Green Fund?

Green Funds will be used for sustainable innovations and eco-events at MMC.

Additional Requests

[% IF ! housing_not_needed %]

Include the following in your additional requests:

  • The ages of children you are bringing, if any. Children under 2 are free; between the ages of 2 and 12 are half-price; age 13 and older, please register him/her separately, as an adult. [% IF ! pr %]
  • Arrival and/or departure dates if they differ from your program's. [% END %]
[% END %]

Important Notes

  • Balance is due on arrival (Visa, MasterCard, cash or check only).
  • $canpol
  • [% IF ! housing_not_needed %]
  • This form does not automatically reserve your spot for the program. You are not registered until we receive your deposit. 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: reservations@mountmadonna.org and programs@mountmadonna.org.
  • [% END %]