Registration Form: (Sep 2017) NDIP Retreat #4: Deep Transformation

New Depths Retreat
Registration Form

Deep Transformation

(September 1-8, 2017)
with Susan Skye and Sarah Peyton

We're delighted you'll be joining us in Portland, Oregon, USA.
To register, please provide the following information.

If you have any questions, please don't hesitate to contact us at newdepthsjourney@gmail.com or 503-862-9224.

Your Contact Information

First Name*

Last Name*

Address - Line 1*

Address - Line 2

City*

State or Province*

ZIP/Postal Code*

Country*

Email Address*

Phone Number*

Country CodeArea CodePhone Number

Phone Number (re-enter)*

Skype ID

Time Zone (UTC)

How did you first hear about New Depths?

What New Depths Intensive Program retreats have you previously participated in? (please check all that apply)

I've completed all 3 retreats of one or more previous Intensive Programs (2010, 2012, 2013, 2015)October 2016January 2017May 2017This will be my first New Depths retreat

Have you previously participated in any other New Depths program? If yes, which one(s)?

Our Program Values & Requested Commitments

The following is a list of values that we'd like our participants to resonate with:

A desire to learn about the brain research findings that relate to healing unresolved childhood pain and promoting well-being

A willingness to engage in and/or witness inner work that may involve intense emotional content

A willingness and ability to be part of a group and to speak in the group

A willingness to value both your own needs and the needs of the other members of our community

1) Do you resonate with our retreat values? (NOTE: If "no," a New Depths retreat may not be the best way to meet your needs at this time.)*

YesNoOther

An essential component of New Depths retreats' effectiveness is the resonant, empathic community that we create during the time we spend together over the weeklong residential retreat.

For this reason, we ask that you honor the container of this sacred healing space and arrive at the retreat center no later than 5pm on the first day of each retreat, and depart from the retreat center no earlier than 1pm on the last day of each retreat.

The September retreat dates are:

September 1-8, 2017 (Friday afternoon to Friday afternoon)

2) Are you committed to attending all days of the retreat(s) you're registering for? (Arriving at the retreat center by 5pm on the first day, and departing the retreat center after 1pm on the last day of the retreat.)*

YesNoOther

Your Hopes and Intentions

What are you hoping for, from your participation in this retreat?*

Your Background/Previous Experience

We would enjoy knowing something about your background. (Note, you don't need any experience in these areas in order to profoundly benefit from this retreat.)

1) Do you have any experience with meditation or any other form of presence practice?

YesNo

1a) IF YES, please share a few words with us about your experience.

2) Do you have any experience with Nonviolent Communcation (NVC, or Compassionate Communication)?

Yes, I'm a CNVC Certified NVC TrainerYes, I'm an Independent NVC TrainerYes, I have experience with NVC (other than teaching NVC)No

2a) IF YES, please share a few words with us about your experience.

3) Are you familiar with the "Living Energy of Needs"?

YesNo

4) Are you a mental health professional?*

YesI'm in training to become a mental health professionalNo

4a) What is (are) your specific field(s) and/or approach(es)?

5) Do you work in the field of personal development? (nonprofessional mental health, coach, etc.)

YesI'm in training in the field of personal developmentNo

5a) Are you associated with any particular group(s) or modality(ies)?

6) Do you have any previous personal or professional experience with brain research and/or interpersonal neurobiology?

YesNo

6a) IF YES, please share a few words with us about your previous experience.

7) Do you have any previous personal or professional experience with trauma and its treatment?

YesNo

7a) IF YES, please share a few words with us about your previous experience.

Your Preferences

Collecting this information will help us to make the retreat experience as comfortable and supportive as possible for you.

1) What kind of lodging arrangement would you like?*

Private Room ($965 room and board)Roommate - I have one already ($765 room and board)Roommate - please assign one for me ($765 room and board)

1a) If you already have a roommate, please enter their name here:

2) What is your gender?*

FemaleMaleOther

3) Please let us know about any special room needs you have.

Fragrance-freeIn-room internet access (NOTE: At Collins Retreat Center this amenity has extremely limited availablity, which we would like to reserve for those whose frequent daily access to the internet has a direct impact on their livelihood. 24-7 wireless internet access is available to all in the common areas.)Other

4) How do you plan to travel to the area (Eagle Creek, Oregon, USA, 45 minutes southeast of Portland, Oregon)?

By airplane (into Portland, Oregon, airport code = PDX)By train (into Portland, Oregon)By car (directly to the Collins Retreat Center in Eagle Creek, Oregon)By local rental carNot sure yet

5) Would you like to participate in the arrival airport shuttle pool, that would reduce your shuttle costs by about 50% (from $60 to $75 down to $30 to $35)? (If you say "yes" or "not sure yet," we'll contact you about 4 weeks before each retreat to get your flight information. About 1 week before each retreat we'll send you a draft arrival shuttle schedule, and you can commit at that time to participating in the arrival shuttle or not. Departure shuttles are organized during the retreat.)

YesYes-wheelchair accessibleNoNot sure yet

Investment and Discount Details

1a) Are you registering with a friend or colleague? (Receive $100 tuition discount per person!)

YesMaybeNo

1b) If you are registering with other(s), please provide their name(s) here.*

At this time, payment in full is due with your registration. After you submit your application, on the next page you'll find a link you can click to pay your program fees with your credit or debit card.

Program fees are as follows:

Double Occupancy = $2130 ($1300 tuition + $765 room/board + $65 online processing fee)
Single Occupancy = $2330 ($1300 tuition + $965 room/board + $65 online processing fee)

If you and a friend are registering together now, each of you can deduct $100 from your program fees.

2) What amount will you be submitting now for your program fees payment? (At this time, payment in full is due with your registration.)*

$2130 Double Occupancy$2330 Single Occupancy$2030 Double Occupancy, registering with a friend$2230 Single Occupancy, registering with a friend

Terms and Policies

1) DEPOSIT TERMS: Your program fees are nonrefundable at this time.*

I have read and accepted the Deposit Terms.

2) CANCELLATION AND REFUND POLICIES: Refunds are not available if you cancel after the start of your retreat week, if you do not show up, or if you leave the retreat early.*

I have read and accepted the Cancellation and Refund Policies.

3) Is there anything else you'd like us to know?

We look forward to having you with us!

If you have any questions, please included them in #3, immediately above.

Warmly,

Susan and Sarah
New Depths

For security, please enter the contents of the field below.*

Registered for Retreat Week #4 (Sep 1-8, 2017)

Sep 1-8, 2017