Upside Thinking Retreat (Off-Site)
First and Last Name:
*
First Name
Last Name
Your Preferred Email Address:
*
example@example.com
Your Cell Number w/ Area code:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Please provide an emergency contact name, cell number and relationship to yourself:
a. Their Full Name:
b. Their Phone Number:
c. Relationship:
Attendance
Please check if you will be joining us for the Day 3 celebration lunch:
Yes
No
Please list any of your dietary needs:
NONE
Allergies (Please List Below)
Other
Allergies – Please Specify:
Other – Write in:
Additional Dietary Comments:
Are you attending the Retreat with anyone?
No
Yes
If Yes, Name of person:
Have you booked your travel already?
Yes
No
If yes, please provide the following information:
Arrival Date:
Arrival Time:
Arriving Flight #:
Arriving City (times given may vary due to traffic/rush hour):
Bluegrass Airport, Lexington (LEX) – 50 minutes from venue
Louisville International Airport (SDF) – 90 minutes from venue
Cincinnati/Northern Kentucky International Airport (CVG) – 95 minutes from venue
How will you get to the event?
Car service (Uber, private company, etc.)
Rental car
Carpooling with another attendee
Media Release
I hereby authorize Upside Thinking, LLC (UT) to use my image/likeness/voice in still photos, slides, video productions, voice recorded productions, radio coverage, television coverage and/or any other media for the purpose of promoting UT and its programs. Additionally, I hereby confirm the consent given you with respect to your photographing me in connection with your video/television program(s) for UT event for which I have registered: and I hereby grant to you, your successor, assigns and licensees the perpetual right to use, as you may desire, all still photos/images of me, all motion pictures and sound track recordings which you may make of me, and the right to use my name in connection with Upside Thinking celebrations and promotions.
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