Retreat Application

Creative Writing Retreats in UK, Mexico and Costa Rica
If you would like to join us for one of these retreats, please complete the following form. We will contact you within 3 working days to confirm your space. An invoice will be provided at that time and the deposit will be payable.

Please indicate which retreat you would like to attend. The following retreats are currently available:
I would like to reserve space(s) on the following retreats (Check all that you wish to attend)

Mexico Writing Retreat, Saturday 30 November – Saturday 7th December 2024Costa Rica Writing Retreat, Sunday 19th January - Sunday 26th January 2025York, UK Writing Retreat, Sunday 9th – Saturday 15th March 2025
On this form, you can secure your spot with a deposit, on the retreat of your choice. Accommodation fees are payable directly to the lodge, a few weeks before travel. Contact julie@centauriarts.com to specify your room preferences.
Primary Traveler/Room Occupant:
Name*

First NameLast Name
Date of birth*

MonthDayYear
Gender*

MALEFEMALE
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone*

Area CodePhone Number
Cell Phone

Area CodePhone Number
E-mail*
I am the sole occupant of the room *

YESNO, I AM ATTENDING WITH OTHER PEOPLE
Where Did you hear about Centauri Arts Retreat?
Accessibility Needs/ Special Requests
Medical Conditions of which we should be aware
Please list any life threatening allergies
Emergency Contact

First NameLast Name
In the unlikely event that you should become ill during the retreat, this is the person we will contact on your behalf.
Phone Number of Emergency Contact

Area CodePhone Number
Relationship to you
WRITING WORKSHOPS
Please tell us a little about your writing interests and experience

Accompanying Traveller 1 staying in the same room:
Name

First NameLast Name
Relationship to primary traveller
Date of birth

MonthDayYear
Gender
Accessibility Needs/ Special Requests
Medical Conditions of which we should be aware
Please list any life threatening allergies
Is this person taking the Creative Writing Workshops?

YESNO
Please tell us a little about your their writing interests and experience

Accompanying Traveller 2 staying in the same room:
Name

First NameLast Name
Relationship to primary traveller
Date of birth

MonthDayYear
Gender
Accessibility Needs/ Special Requests
Medical Conditions of which we should be aware
Please list any life threatening allergies
Is this person taking the Creative Writing Workshops?

YESNO
Please tell us a little about your their writing interests and experience

End
A deposit is required per room to secure space. This deposit is payable in Canadian dollars and covers the portion of the tour supplied by Centauri Arts: Creative Writing Workshops and related activities/materials, plus group leader services. The deposit fees due are as follows:

Mexico Retreat:          $675 CDN per writer
                               $150 CDN for accompanying family/friends sharing a room

Costa Rica Retreat      $695 CDN per writer
                                 $150 CDN for accompanying family/friend sharing a room

York, UK Retreat        $650 CDN per writer
                                 $150 CDN for accompanying family/friend sharing a room

Please specify below how you would like to pay. Once we have confirmed availability of your room, we will call or email you to finalise payment.
I wish to pay by

Interac (Canadian Customers only)Credit card
I have read, understand and agree to the booking conditions in the retreat handout.*

YES
ELECTRONIC SIGNATURE: By entering my name in the space below, I certify the information provided is true and correct, and legally obligate myself to the same extent as I would by signing my name on a printed version of this form
Full Name of Person completing this form.

First NameLast Name
Date

MonthDayYear
Should be Empty:

Creative Writing Retreats in UK, Mexico and Costa Rica