REGISTRATION IS NOW CLOSED 2024 Winter Retreat Registration Sunday, December 29th to Wednesday, January 1st Name (as you would like it to appear on your name tag) * Preferred Pronouns * She/Her He/Him They/Them Other I prefer not to provide pronouns If you selected "Other" for your preferred pronouns, please tell us what they are: Gender Identity * Male Female Non-Binary Trans Male Trans Female Gender Non-Conforming Gender Fluid Other I prefer not to provide a gender identity If you selected "Other" for your gender identity, please tell us what yours is: Accommodation & Accessibility Preferred Sleeping Accommodations: * Male Dorm Female Dorm Reserved space for nonbinary or trans persons (if preferred) No preference If you have any mobility limitations, please let us know about them: Membership Membership Affiliation (select all that apply) * SA (Sexaholics Anonymous) SAA (Sex Addicts Anonymous) SCA (Sexual Compulsives Anonymous) SIA (Survivors of Incest Anonymous) SLAA (Sex & Love Addicts Anonymous) CoSA (Codependents of Sex Addicts) S-Anon Supportive Partner of an S-Member Personal Information (Will be kept confidential) Email * Phone * (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Service Rideshare * I can offer a ride I need a ride I am not available for rideshare Service Position Availability (select all that apply) * Helping prior to the retreat On location set-up Sunday On location clean-up Wednesday On location TBD help during the retreat No, I am not available to provide service Please let us know if you have a preferred way to provide service Breakout Sessions If you would like to host a breakout session, or have a special interest that you would like to see explored, please describe here. Would you like to perform in Creative Expressions? * Creative Expressions is an event where people showcase their talents and creativity. Spots are limited, and time per performance is capped at 5 minutes. If you would like to participate, please let us know here. Yes No Undecided (this option does not secure your spot) If you selected "yes" please describe what you will be performing Food Meal Plan * General Vegetarian Vegan (LaSalle Manor suggests vegan guests bring their own food to supplement what they can offer) Gluten Free Please list any food allergies Will you be bringing a dish to the Potluck Sunday night? * Yes No, I will be contributing $20 towards catering instead I will not be in attendance Sunday night If yes, what will you be bringing? Payment Will you need a scholarship? * Yes No Contribution to Scholarship Fund Scholarships are 100% funded by individual 7th tradition donations. If you're able to contribute to the scholarship fund, it helps individuals attend who otherwise could not. $ Plan Option * Plan A: Sunday-Wednesday (8 meals, 3 nights) - $395 Plan B: Sunday-Tuesday (6 meals, 2 nights) - $310 Plan C: Monday-Wednesday (8 meals, 2 nights) - $325 Registration + 7th Tradition! (for those donating to scholarship fund) = Registration fee + donation amount (Scholarship applicants) Plan A: Partial payment of $198 (Scholarship applicants) Plan B: Partial payment of $155 (Scholarship applicants) Plan C: Partial payment of $163 Payment Method * Zelle or CashApp (instructions will follow after submission) Other method (pre-arrange with retreat chairs by emailing chicago.s.retreat@gmail.com) Thank you!
