Workshop Registration Form If you would like to attend the Spiritual Retreat & Workshop with Derek O’Neill in Ireland please complete the form below. Once this is complete, please make your deposit. Workshop Date Please complete a form for each workshop you wish to attend. JANUARY 13-20, 2019MAY 12-19, 2019SEPTEMBER 22-29, 2019 Contact Information Name Email Telephone Number Address Emergency Contact Dietary Considerations Please list any dietary restrictions or if you are a vegetarian. Accommodation If you would like to request a specific roommate please add their name below. Add me to the wait list for a private room (a single supplement charge will apply) I am a local resident and do not require accommodation Please indicate what room-type you require. Room with 2 twin-bedsRoom with 1 double bed Please indicate your gender. femalemale Arrival Are you arriving late (after Sunday evening)? If so, which day? Departure Are you departing early? If so, which day? Workshop Policy On receiving this completed form, we require a minimum deposit payment of €500 to confirm your application. Eight weeks prior to the event, we require an additional €500 and any outstanding balance will be required four weeks prior to the workshop. The 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 the workshop. Thank you for your cooperation and understanding. I have read and accept these conditions. 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.