Fall 2019 Registration Form Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Email*Please provide an e-mail address where we can easily contact you. All correspondence, including registration confirmation, further important retreat information and any updates will be sent via email from email@example.com — so it is critical that you have approved our email address. Housing choice*There are very few single rooms and they are assigned on a first-come, first-served basis. Single rooms are mostly in the larger cottages. Every bed is a twin bed. There are no queen beds. NOTE :: there are no single rooms left available at the retreat, only shared rooms. Please indicate below that you are happy with a shared room, or if you would like to be waitlisted for a single room, should one become available.Shared room for me!Please waitlist me for a single room.Off CampusMy pronouns are:* she/her he/him they/their Are you planning to share a room with a specific person? If yes, please indicate here:ARE THERE PEOPLE THAT YOU WOULD LIKE TO SHARE A COTTAGE WITH? IF YES, PLEASE INDICATE HERE:Please include their first and last names. Please also note that we cannot make any promises, but we will do our best! Please provide emergency contact info.First and last name*Phone Number*OPTIONAL INFORMATIONThese questions are OPTIONAL, but are extremely helpful for assigning cottages and shared rooms.BEST WAY TO START THE DAY?BEST WAY TO END THE DAY?WORD(S) TO DESCRIBE HOW YOU HOPE THIS WEEKEND WILL FEEL?If any of the following is important to you, please check all that apply. Note: singles are mostly in larger cottages.Bedtime I prefer to go to sleep early and enjoy a quiet cottage in the evenings I am on holiday and enjoy lively conversations by the fireside —no bedtime for me! Cottage size I prefer to be in a larger cottage 5+ people I prefer to be in a smaller cottage 4 people or less Ages I am here for the experience and enjoy sharing space with people of all ages I would like to be with other attendees who are between the ages of: Dietary Restrictions I am vegetarian I am vegan I am gluten-free Other 20-30 30-40 40-50 50-60 60+ Other dietary restriction(s):How did you hear about Squam Art Workshops?Recommendation by a friendSquam NewsletterInstagramFacebookTwitterGoogle SearchOtherIf other, please specify:I have attended Squam previously.NoYesWhich sessions?ANY OTHER INFORMATION YOU WOULD LIKE US TO KNOW? (if you have a cottage request, please let us know here)Class choicesPlease use the following dropdowns to indicate your FIRST, SECOND and THIRD class choices for each day. For more information on each class and updated class availability please visit: squamartworkshops.com. NOTE: You will have a total of TWO 5-hour classes: one on THURSDAY, one on FRIDAY.THURSDAY - first choice*choose oneAutumn SplendorMultiplicitySweet TalismanAssemblageTHURSDAY - second choice*choose oneAutumn SplendorMultiplicitySweet TalismanAssemblageTHURSDAY - third choice*choose oneAutumn SplendorMultiplicitySweet TalismanAssemblageFRIDAY - first choice*choose oneAutumn SplendorSweet TalismanFRIDAY - second choice*choose oneAutumn SplendorSweet TalismanFRIDAY - third choice*choose oneAutumn SplendorSweet TalismanPayment informationI pre-registered:YesNoPaypal email used to register:Please choose from the following options:On campus registrations include all workshops, evening events, 4 nights lodging, full meal plan (4 breakfasts, 3 lunches, 4 dinners) Off campus registrations include all workshops, evening events, 3 lunches, 1 dinner (Wednesday)On campus attendee: 1390 USD*Off campus attendee: 790 USD*The following options are available for off-campus attendees: 4 breakfasts: 45 USD 3 dinners: 65 USD Due today:A non-refundable deposit fee of $350 USD is required to process your registration. You may also elect to pay the full balance today. Payment by check is preferred. (Once your Registration is submitted, you will be re-directed to a page with payment instructions) You may also elect to pay via PayPal.Please indicate your payment type:Pay by checkPay by PayPalCancellation Policy: No refunds after May 31st, 2019. Pre-Registration fee is non-refundable or transferable. Also, Pre-Registration is a separate, additional fee. Deposits are non-refundable and non-transferable. There are no exceptions. All requests for refunds must be received in writing before May 31st, 2019. (You may have someone else take your spot before August 15th, 2019, but we must be notified of all changes). In the case of acts of God, war, disaster or unforeseen circumstances, Soliden LLC reserves the right to reschedule Squam Art Workshops.Release form:* I have read all the above policy information and I agree to assume all risk of personal harm or injury relating to or resulting from my participating in all workshops and activities associated with Squam Art Workshops, and to hold Soliden LLC and its teachers, harmless as to liability for any such harm or injury. Accuracy statement:* I have triple-checked the Registration Form for accuracy and found the information to be true and correct.