Register for MAVN Retreat

Complete the following form to register. Please click on sections 1-6 below to complete each section.

1. Basic Information

Emergency Contact

Below we ask about a "contact person" in case of emergencies. This should be a person who can either collect you from the retreat or help to make transportation arrangements if you need to leave the retreat early. It may be a person outside the US if you are coming to the retreat from there.

Medical Information

Below please supply the names of any prescription medications that you are taking for mental health or behavioral conditions. This information will remain confidential except in the event of an emergency.

2. Retreat Experience

Ex: Lunch on 6/10

Please describe your other dietary restrictions here. We are limited in the dietary restrictions that we can accommodate. If you have significant restrictions, we may ask you to bring some of the needed items. Limited refrigeration space is available.

Ex. Using stairs, walking the length equal to 1 city block, etc. If so, we would like to accommodate you in whatever way we can.

If you would like to share a room with a particular person, please list their name.

Except for couples requesting to room together, or those paying for single rooms, we assign retreatants to roommates of the same gender identity.

At MAVN some of our retreatants provide body work to others, during hours of their choice, for either dana (donations) or payment.

On the first and last day of the retreat, many of our retreatants are arriving from / departing to the train station or the airport. Many retreatants offer car rides to other retreatants on these days.

3. Registration Fee

The actual daily cost of the retreat is reflected in Tier 3. If you choose a higher tier, your additional contribution will help to pay for someone who chooses Tier 4 or 5 rather than asking for financial assistance. Anyone who pays above the daily cost will be making a tax-deductible contribution and receive a statement to that effect for tax purposes. Full payment is due upon registration. If you'd like financial support through MAVN's financial aid or diversity initiative funds, choose the corresponding option below. Single rooms are available to those with medical necessity or for an additional fee to those registering at tiers 1-3 or receiving Diversity Initiative Funds.

Single Rooms are only available at tiers 1, 2, and 3; or, for health reasons.

Financial Aid Questions

The following questions are only required if you are applying for financial aid.

4. Donation

As you know, expenses for retreats are increasing while personal incomes often are not. This means that more people who want to—or need to—come to a MAVN retreat cannot afford the cost. It is our policy not to turn anyone away for financial reasons. Please help us live that policy. Scholarship contributions, general donations to MAVN, and payments above the daily rate, are all tax-deductible. If you have made any of these donations with your application, at the retreat we will provide you with a statement of your contributions for your records.

Enter the numeric dollar value.

5. Legal

Cancellation Policy

Full payment with registration is due February 7, 2018. Cancellations up to February 7, 2018 will receive a 75% refund; between February 8, 2018-February 22, 2018: 60% refund. If we are unable to fill your space, there will be no refund for cancellations after February 21, 2018, when we confirm attendance and become financially obligated to the Center. We will confirm your cancellation refund amount after the retreat.

Waiver of Liability and Authorization for Emergency Medical Treatment

I voluntarily agree to participate in retreat activities, including service positions. If I have any concern about my ability to safely complete a retreat activity, including a service position, I will notify the retreat manager immediately. I also realize that there may be unanticipated risks during such activities. I hereby assume all risk of injury to me and damage to my property that might be sustained in connection with activities undertaken on this MAVN retreat.

I understand that MAVN is not expected or able to provide medical and/or psychological care. I agree that, in the event that a representative of MAVN determines that I need professional medical or psychological attention, MAVN has the authority and sole discretion to contact 911 emergency services, and/or to contact the designated emergency contact person I have indicated below.

Any costs incurred for health services are my responsibility and not the responsibility of MAVN.

I understand that participation in MAVN retreat activities is at the discretion of the teacher and MAVN staff at all times. If, in the opinion of these persons, it is inadvisable for me to continue to participate at the retreat, and I am asked to leave, I agree to do so promptly.

If I am taking prescription medications of any kind, and I discontinue taking them during the retreat, I understand that this may be grounds to be asked to leave, and I agree to do so promptly.

I understand that I must provide the name and contact details of an emergency contact person in order to attend the retreat, and that I will not be allowed to participate unless I have done so. MAVN will make every effort to communicate with this person in the event of an emergency. Therefore, I am listing a person who can either collect me from the retreat in an emergency, or who can help to make transportation arrangements if I need to leave the retreat early.

I have read this agreement and fully understand its contents. I sign it of my own free will. I am of legal age and accept the above disclaimer and authorization.

You must sign with your legal name.

6. Payment

Summary Amount
Tier
Single Room
Donation
Processing Fee (2.9% + $0.30)
Total

Make check payable to MAVN, and mail your payment to:

Steve Burns
607 Crestwood Drive.
Alexandria, VA 22302

Summary Amount
Tier
Single Room
Donation
Total