November 7-10, 2024 Shakertown, KY $450 At this time the retreat is full, but you are welcome to sign up for the waitlist and we will notify you if/when an opening occurs. Personal Information Name * Email * Phone * Date of birth Address * City * State * Select... Alabama (AL) Alaska (AK) American Samoa (AS) Arizona (AZ) Arkansas (AR) California (CA) Colorado (CO) Connecticut (CT) Delaware (DE) Dist. of Columbia (DC) Florida (FL) Georgia (GA) Guam (GU) Hawaii (HI) Idaho (ID) Illinois (IL) Indiana (IN) Iowa (IA) Kansas (KS) Kentucky (KY) Louisiana (LA) Maine (ME) Maryland (MD) Marshall Islands (MH) Massachusetts (MA) Michigan (MI) Micronesia (FM) Minnesota (MN) Mississippi (MS) Missouri (MO) Montana (MT) Nebraska (NE) Nevada (NV) New Hampshire (NH) New Jersey (NJ) New Mexico (NM) New York (NY) North Carolina (NC) North Dakota (ND) Northern Marianas (MP) Ohio (OH) Oklahoma (OK) Oregon (OR) Palau (PW) Pennsylvania (PA) Puerto Rico (PR) Rhode Island (RI) South Carolina (SC) South Dakota (SD) Tennessee (TN) Texas (TX) Utah (UT) Vermont (VT) Virginia (VA) Virgin Islands (VI) Washington (WA) West Virginia (WV) Wisconsin (WI) Wyoming (WY) Other Zip Code * Retreat Information How did you hear about this retreat? * Room Accommodations * Happy to share a room/suite with private bath Prefer my own room with a private bath (+$150) Single Rooms are limited and available on a first come, first served basis. Roommate Request Health Information Do you have any food allergies or dietary restrictions? If so, please describe here: Shaker Village can accommodate food allergies and dietary restrictions for all meals as long as we know before the event. Do you have any medical of physical needs that you would like us to be aware of (i.e. CPAP, high blood pressure, physical mobility, etc.)? If so, please describe here: Name for Emergency Contact Phone for Emergency Contact Payment Information $150 deposit is required with registration or you can choose to pay the full retreat amount. For this event we can accept payment through Venmo, Cash App, Zelle, or a mailed check. We are not able to accept credit cards at this time. We are able to refund any/all payments before September 30, 2024 if your plans change and you cannot attend the event. Payment Amount * $150 - Deposit (Required) $450 - Full Retreat $600 - Full Retreat with single room requested Payment Type * Select One Venmo Cash App Zelle I'll mail a check QR payment codes or address to mail a check will show after your registration is successful Additional Comments