Deep Refuge: A LGBTQIA+ Community Retreat in Nature

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1 Welcome

3 Optional Items

4 Participant Info

Phone *
Second Phone
Address *
Address 2
City *
State/Prov. *
Zip/Postal *
Country *
Are you a person who identifies as LGBTQIA (lesbian, gay, bisexual, transgender, queer, intersex, and asexual)? *	This is a retreat for LGBTQIA-identified people. If you do not identify as such, we are happy to help you find another VMRC retreat.
Please specify LGBTQIA identity here
What is your gender pronoun? (optional)
Please specify gender pronoun here
Are you a person who identifies as BIPOC (Black, Indigenous or Person of Color)? (optional)	Vallecitos asks this question to know if you are eligible for specific BIPOC Scholarship funds. We care to support our BIPOC community.
Please specify BIPOC identity here
Birth Date (optional)	Knowing this helps us with housing assignments.
Do you have any physical health or mobility issues we should be aware of? *	If yes, please describe in the space provided. Please enter "no" otherwise.
Do you need to use a CPAP machine? *	If yes, please be sure to see very important CPAP information on our website under the Planning your visit Medical page. Those using CPAP machines that are powered by electricity will be assigned to either casita 3 or 4, where we have solar batteries available. You must register for a casita if you plan to use your plug-in CPAP. If you bring your own rechargeable batteries or solar power source to run your CPAP then you may choose any lodging type.
Medically Necessary Dietary Requests	Gluten Free Dairy Free Lactose free Soy Free Egg Free Nut Free Vegan, includes no Honey Vegan, eats Honey Specific Food Allergy (please explain below) Other (please explain below) If you have an allergy, please use the question below to adequately describe the nature of the allergy (for example, is the allergy anaphylactic?).
Diet Notes	Please explain any medically necessary dietary requests.
You will receive a practice discussion questionnaire two weeks before arrival. In the meantime, it is important for us to understand what supports you. Do you have any personal or psychological situations/diagnoses that would potentially require additional support or impact your retreat? *	If yes, please briefly describe the situation or diagnoses and how it might affect your retreat. Due to the remoteness of our center, this information will allow us to support your well being as fully as possible. Please enter "No" otherwise.
If you are a medical professional and would be willing to assist in the event of a medical emergency in our remote location, kindly note your profession and willingness here. (optional)
Emergency Contact Name *	Please include their relationship to you, e.g. sibling, spouse, parent, friend.
Emergency Contact Phone *
Have you sat a silent meditation retreat away from home before?	Yes No This retreat is open to new and experienced practitioners. We ask this question to better understand the prior experience of participants.
Have you been to Vallecitos before?	Yes No
How did you hear about this retreat?
Comments or Special Needs
Email newsletter	Please send me the email newsletter
Cancellation Policy *	I have read and understood the cancellation policy.CANCELLATION POLICY: 45+ days = full refund, less nonrefundable $150 fee; 45-22 days = 50% refund; 0-21 days = no refunds. Cancellation policy applies to all registered guests including scholarship recipients. For more detail visit our website here.
Terms and Conditions *	I have read and understood the terms and conditions for using this site.Please read the terms and conditions.

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5 Donate to Vallecitos and Support Accessibility

$	Donate to Vallecitos and support accessibility. Supporting others to be able to attend retreat is only made possible through the generous support of donations. Please make a donation to help us sustain Vallecitos and a robust scholarship fund. Thank you!

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1 Welcome

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Casita Benefactor Rate (I am resourced and can help another)

Casita Actual Rate (I can cover myself)

Casita Scholarship Rate (A lower rate would help me attend)

Yurt Benefactor Rate (I am resourced and can help another)

Yurt Actual Rate (I can cover myself)

Yurt Scholarship Rate (A lower rate would help me attend)

Tent Cabin Benefactor Rate (I am resourced and can help another)

Tent Cabin Actual Rate (I can cover myself)

Tent Cabin Scholarship Rate (A lower rate would help me attend)

Hermitage - Supporting scholarships and land stewardship

Hermitage - Supporting scholarships

Hermitage - A secluded cabin

Tent Camping

3 Optional Items

4 Participant Info

5 Donate to Vallecitos and Support Accessibility

6 Payment