Retreats Alaska: 2022 Backpacking Retreat Registration

2022 MindBodySoul Alaskan Backpacking Retreat Registration

Once this form is completed, you will receive an invoice to pay your deposit or retreat payment, and your registration will be officially complete!

Thank you!
Stephanie & Ben, Retreats Alaska

Your Name *

First Name Last Name

E-mail *

Phone Number *

Include ext.

Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Select your retreat

Alaskan Backpacking Retreat $ 2,500.00

JULY 14-17, 2022

Quantity

Alaskan Backpacking Retreat (Alaska Resident Special) $ 999.00

JULY 14-17, 2022This special pricing is for Alaska residents only. Registration for this price availability ends May 1st, 2022. Photo ID is required for proof of residency.

Quantity

Subtotal $ 0.00 Tax $ 0.00 Total $ 0.00

Retreat Cost: $2,500 + tax Resident Retreat cost: $999 + tax *

I agree to pay retreat cost in full by June 15, 2022

Select your Payment Agreement

I wish to pay $2,500 + tax in full today I wish to pay $999 + tax in full today (AK Resident Rate Only) Pay 50% deposit today, with monthly payments until paid in full by June 15th, 2022

Will this be your first time traveling to Alaska?

Yes No

How would you describe your current physical fitness level?

DESCRIBE YOUR PRIOR BACKPACKING EXPERIENCE

Beginner Backpacker Some overnight experiences Multi-Day Backcountry

WOULD YOU LIKE coaching & assistance FOR OUTFITTING YOURSELF WITH THE PROPER FOOD, GEAR AND EQUIPMENT?

Yes, please! No thanks, I am all set

Health & Emergency Information

Please list any food or medication allergies. *

List your allergies here

Please list any prior medical conditions or medications that may affect you during this retreat. *

List any pertinent medical information here

Emergency Contact *

First Name Last Name

Emergency Contact Phone Number *

Area Code Phone Number

Terms and Conditions

PLEASE READ AND ACCEPT THE TERMS OF THE FOLLOWING STATEMENTS

I agree to the following terms & Conditions *

TERMS AND CONDITIONS: I affirm that I have read completely and agree to comply with the Terms & Conditions listed on the Retreats Alaska website I agree & understand my Client Responsibilities: 1. All clients will be required to follow the safety policies and procedures of MindBloom Alaska, LLC d/b/a Retreats Alaska (“M.R.A.”) and the guides’ instructions during activities. 2. All clients will be required to sign a Participant Release of Liability, Waiver of Claims, Assumption of Risks and Indemnity Agreement in favor M.R.A. before departing on any trip; and 3. Each client agrees and acknowledges when they sign up for an M.R.A. activity that they have significant responsibility for their own safety and that they agree they are ULTIMATELY RESPONSIBLE for their own safety during participation in a tour.

Signature: (Use Mouse to Sign) *

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