Preferred Pronouns *

She/Her

He/Him

They/Them

Other

I prefer not to provide pronouns

Gender Identity *

Male

Female

Non-Binary

Trans Male

Trans Female

Gender Non-Conforming

Gender Fluid

Other

I prefer not to provide a gender identity

Preferred Sleeping Accommodations: *

Male Dorm

Female Dorm

Reserved space for nonbinary or trans persons (if preferred)

No preference

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

Phone *

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

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 Friday

On location clean-up Monday

On location TBD help during the retreat

No, I am not available to provide service

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)

Meal Plan *

General

Vegetarian

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

Gluten Free

Will you be bringing a dish to the Potluck Friday night? *

Yes

No, I will be contributing $20 towards catering instead

I will not be in attendance Friday night

Will you need a scholarship? *

Scholarships are awarded on a first-come first-served basis, and are not guaranteed. Your payment of $200 secures your spot "in line" and you will be notified as soon as the 7th tradition funds become available to cover your scholarship.

Yes

No

What day will you be arriving? (if outside of the Friday-Monday timeline)

MM

DD

YYYY

At what time will you be arriving on the day above? (if outside of the Friday-Monday timeline)

Hour

Minute

Second

AM PM

What day will you be leaving? (if outside of the Friday-Monday timeline)

MM

DD

YYYY

At what time will you be leaving on the day above? (if outside of the Friday-Monday timeline)

Hour

Minute

Second

AM PM

Payment Method *

Zelle or CashApp (instructions will be on the next page)

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