2021 Into the Mystic Registration Name* First Last My pronouns are:* she/her he/him they/them Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican 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 RicoQatarRomaniaRussiaRwandaRéunionSaint 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 IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands 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 firstname.lastname@example.org — so it is critical that you have approved our email address. Phone*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?What are your hopes/intentions for the week?If any of the following is important to you, please check all that apply.Dietary Restrictions I am vegetarian I am vegan I am gluten-free Other 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.NoYesNumber of times attended:Which sessions?ANY OTHER INFORMATION YOU WOULD LIKE US TO KNOW?Payment information1590 USD :: FULL WEEK Retreat Includes all workshops, excursions and meal plan (meal plan: 5 lunches, 4 afternoon snacks, 2 dinners)Due today:A non-refundable deposit fee is required to process your registration. You may also elect to pay the full balance today. - 350 USD 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. *ALL attendees outside the USA must pay via Paypal.Choose your payment type:Pay by checkPay by PayPalCancellation policy: Deposits are non-refundable or transferable. No refunds after April 15th 2021. There are no exceptions. All requests for refunds must be received in writing before April 15th 2021. (You may have someone else take your spot before April 15th 2021, 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. In the event of a resurgence of the pandemic which requires a cancellation of the event, we will refund ALL monies paid to date, minus a 200 USD admin fee.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.