Workshop Registration Form

Workshop Details

*Which workshop do you wish to attend?

JANUARY 12-19, 2020MAY 17-24, 2020SEPTEMBER 13-20, 2020

*What format are you signing up for?

ZoomCreacon

Contact Information

*Name

*Email

*Telephone Number

*Address

*Emergency Contact

*Please indicate your gender.

femalemale

Financial Wellbeing

If you cannot afford to attend at this time, please do not put yourself at financial risk.

Are you financially stable?

YesNo

Mental Wellbeing

This workshop explores mindfulness and self development, as such it is best suited for those who are emotionally and mentally healthy.

Are you currently seeing a mental health professional?

YesNo

Creacon Attendees

Please fill our the dietary and accommodation section if you are planning to stay at Creacon.

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. Due to demand, it is unlikely this option will be available.)

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 bedDormitory Room (€300 discount)

Workshop Policy

Upon 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 deposits are neither refundable nor transferable. Any amount in excess of the deposit can be refunded up to 21 days prior to the workshop. Within 21 days of the start of the workshop, 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. You also agree not to record any part of the session with Derek by any means including audio, video or screen recordings. 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.