Name

Gender
femalemale

Email

Telephone Number

Address

Please list any dietary restrictions

Emergency Contact

If you would like to request a specific roommate, add their name below and indicate if you would like to share a bed or have separate beds

Are you arriving late (after Sunday evening)? If so, which day?

Are you departing early (before Saturday's banquet dinner)? If so, which day?

Workshop Policy

On receiving this completed form, we require a minimum deposit payment of €500 to confirm your application unless you enroll in an automated subscription plan. Eight weeks prior to the event (April 15th), we require an additional €500 and any outstanding balance will be required four weeks (May 13th) prior to the workshop. These first and second mandatory deposits are neither refundable nor transferable. Any amount in excess of these amounts can only be refunded up to two weeks prior to the workshop. Within and after these final two weeks, no refund or transfer is allowed. Please note that your full investment must be submitted prior to June 11th. Thank you for your cooperation and understanding.

By checking this box, and submitting this application, you agree to assume all risks incurred in participating in the workshop including physical injury; and agree to hold Derek OʼNeill and any associated entities harmless for such injury. You further agree that your image may be recorded and used as Derek, in his sole discretion, deems fit. Please note, we highly recommend that anyone with a history of mental instability, receiving psychiatric treatment or actively taking anti-psychotic medication please seek the advice of your doctor and in doing so attend the workshop at your own risk.

Please Note: The form will not send unless you check the box above.
Remember to complete your investment exchange in "Step 2" on previous page after you submit this form.