Register for the
All-S Summer Retreat

Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Ride Share

Carpooling

I can offer rides

I need a ride

I'm not available to carpool

Service Position Availability

Yes - Helping prior to the retreat

Yes - On location set-up Friday

Yes - On location clean up Monday

Yes - On location tbd help during the retreat

No, I am not available to provide service

Membership Affiliation *

SAA (Sex Addicts Anonymous)

SCA (Sexual Compulsives Anonymous)

SLAA (Sex and Love Addicts Anonymous)

SA (Sexaholics Anonymous)

SRA (Sexual Recovery Anonymous)

SIA (Survivors of Incest Anonymous)

S-Anon

Supportive Partner of an S-member

Other: please let us know your affiliation. If you selected more than one affiliation, let us know if one is your primary (if applicable)

Meal Options *

General

Vegetarian

Vegan (*LaSalle Manor suggests vegan guests bring their own food to supplement what they can offer)

Gluten Free

Gender Identity *

Female

Male

Non-Binary

Other (Please let us know your gender identity. )

Gender + Accomodations *

La Salle Manor has 2 main floors of single occupancy rooms. One floor will accommodate men, and one will accommodate women. There are also a couple of individual rooms separate from the main dorms. If you identify outside the binary spectrum, we want to accommodate you where you feel most comfortable. Would you prefer to be on the male floor, female floor, or separate accommodations?

Female Floor

Male Floor

Separate Accommodations

Preferred Pronouns *

She/Her/Hers

He/Him/His

They/Their/Theirs

Other (Please let us know your preferred pronouns. If you selected more than one set, let us know if there is a primary preference.)

Do you need Scholarship?

50% financial assistance is available on a first come, first serve basis. Must register and pay 50% now. Co-chairs will notify you on May 12th if scholarship is available (subject to availability of funds). If not, you will have the option to pay the remaining balance or receive a refund (of the already paid $).

Yes

No

Plan *

If special arrangements are needed, please contact us at chicago.s.retreat@gmail.com

Plan A: Friday-Monday (8 meals).- $340

Plan B: Saturday-Monday (8 meals) - $340

Plan C: Friday-Sunday (6 meals) - $275

Payment *

All payments are to be made via Zelle or Cash App (follow the links provided in registration confirmation email) or via check/other methods with prior arrangement

FOR PLAN A or B: Total Payment of $340

For PLAN C: Total payment of $275

For PLAN A or B (Scholarship applicants): Partial payment of $170

For PLAN C (Scholarship applicants): Partial Payment of $138

Other amount (for those donating to scholarship fund) = Registration fee + donation amount

Payment Method *

How would you like to pay?

Zelle (follow link in confirmation email)

Cash App (follow link in confirmation email)

Check (pre-arrange with retreat chairs via emailing chicago.s.retreat@gmail.com)

Other method (pre-arrange with retreat chairs via emailing chicago.s.retreat@gmail.com)