1Choose Retreat2Registrant Info3Our Policies4Checkout HiddenSubmission Date: REGISTERING FOR A RETREAT HiddenSelect retreat type:* Teacher-Guided Group Retreat Supported Self-Retreat Zoom Retreat Please proceed to the next section for the pull-down list of group retreats currently open for registration.ZOOM RETREAT REGISTRATIONPlease select the retreat you would like to attend from the menu below.Choose a Zoom Retreat*Choose a retreatHeather Sundberg, July 24-27, 4 nightsHiddenZoom Retreat Name zoom retreat name to DB exportHidden3 Day Zoom Retreat – Please select the rate that you can contribute for this retreat.* Subsidized Rate – $150 Plus dana offerings. Sustaining Rate – $180 Plus dana offerings. Supporting Rate – $210 Plus dana offerings. 4 Day Zoom Retreat – Please select the rate that you can contribute for this retreat.* Subsidized Rate – $200 Plus dana offerings. Sustaining Rate – $240 Plus dana offerings. Supporting Rate – $280 Plus dana offerings. Hidden7 Day Zoom Retreat – Please select the rate that you can contribute for this retreat.* Subsidized Rate – $350 Plus dana offerings. Sustaining Rate – $420 Plus dana offerings. Supporting Rate – $490 Plus dana offerings. * Experience requirements are in place for this retreat. Retreats are offered on a tiered fee scale. During this time of economic hardship, by paying at the highest level you can afford you are providing much needed support to Cloud Mountain. SUPPORTED SELF-RETREAT REGISTRATION What days would you like to attend the retreat?Arrival Date: MM slash DD slash YYYY Departure Date: MM slash DD slash YYYY * Please check your dates and ensure that your arrival date is before your starting date.Length of Stay:daysPlease select the rate that you can contribute for this self-retreat.* Subsidized Rate – $70 per day plus dana offerings Sustaining Rate – $80 per day plus dana offerings Supporting Rate – $90 per day plus dana offerings Full Cost of Self-Retreat at Subsidized Daily Rate* Price: $0.00 Full Cost of Self-Retreat at Sustaining Daily Rate* Price: $0.00 Full Cost of Self-Retreat at Supporting Daily Rate* Price: $0.00 HiddenTEACHER-GUIDED GROUP RETREAT REGISTRATIONPlease select the retreat you would like to attend from the menu below.Choose a retreat:*Retreats marked with an asterisk require experience. Please be sure to reflect this in the “Meditation Experience” section.Choose a retreatApril 29 – 30 Volunteer Work PartyMay 5 – 10 with Keri Pederson & Tim Geil, 5 nightsMay 12 – 17 with Mark Nunberg & Shelly Graf, 5 nights*May 19 – 25 with Stephen Snyder, 6 nightsMay 26 – 31 with Tuere Sala & Keri Pederson, 5 nights*June 2 – 15 with Ayya Santussika Bhikkhuni & Ayya Cittananda Bhikkhuni, 13 nightsJune 16 – 22 with Tina Rasmussen, 6 nightsJune 23 – 29, Young Adult Retreat with Keri Pederson & Shelly Graf, 6 nights*June 30 – July 9 with Kamala Masters & Steve Armstrong, 9 nights*July 21 – 27 with Stephen Snyder, 6 nightsJuly 28 – August 2 with Tuere Sala & Tim Geil, 5 nights*August 11 – 24 with Tina Rasmussen, 13 nightsAugust 25 – 30 with Carole Melkonian, 5 nights*September 1 – 7 with Narayan Liebenson & Tim Geil, 6 nightsSeptember 8 – 13 with Shelly Graf & Vance Pryor, 5 nightsSeptember 15 – 18 with Keri Pederson, 3 nightsSeptember 22 – 27 with Kamala Masters & Mark Nunberg, 5 nights*September 29 – October 12 with Santikaro, 13 nightsHiddenRetreat Name (hidden) Copies the LABEL (name of retreat) from Retreat List ( Field 1) for DB Entry, uses JS Code from ( contained in Field 61) to copy Label instead of Value HiddenVisibility Off/On off Hidden2 Day Retreat – Please select the rate that you can contribute for this retreat.*Please note that the Cloud Mountain Cancellation & Housing Policies remain the same & are not based on the price you choose. Click here for more information about tiered fees. Subsidized Rate – $210 Plus dana offerings. Sustaining Rate – $240 Plus dana offerings. Supporting Rate – $270 Plus dana offerings. 3 Day Retreat – Please select the rate that you can contribute for this retreat.*Please note that the Cloud Mountain Cancellation & Housing Policies remain the same & are not based on the price you choose. Click here for more information about tiered fees. Subsidized Rate – $210 Plus dana offerings. Sustaining Rate – $255 Plus dana offerings. Supporting Rate – $300 Plus dana offerings. Hidden2020 – 3 Day Retreat – Please select the rate that you can contribute for this retreat.*Please note that the Cloud Mountain Cancellation & Housing Policies remain the same & are not based on the price you choose. Click here for more information about tiered fees. Subsidized Rate – $210 Plus dana offerings. Sustaining Rate – $230 Plus dana offerings. Supporting Rate – $250 Plus dana offerings. Hidden4 Day Retreat – Please select the rate that you can contribute for this retreat.*Please note that the Cloud Mountain Cancellation & Housing Policies remain the same & are not based on the price you choose. Click here for more information about tiered fees. Subsidized Rate – $280 Plus dana offerings. Sustaining Rate – $310 Plus dana offerings. Supporting Rate – $340 Plus dana offerings. 5 Day Retreat – Please select the rate that you can contribute for this retreat.*Please note that the Cloud Mountain Cancellation & Housing Policies remain the same & are not based on the price you choose. Click here for more information about tiered fees. Subsidized Rate – $350 Plus dana offerings. Sustaining Rate – $425 Plus dana offerings. Supporting Rate – $500 Plus dana offerings. Hidden2020 – 5 Day Retreat – Please select the rate that you can contribute for this retreat.*Please note that the Cloud Mountain Cancellation & Housing Policies remain the same & are not based on the price you choose. Click here for more information about tiered fees. Subsidized Rate – $350 Plus dana offerings. Sustaining Rate – $380 Plus dana offerings. Supporting Rate – $410 Plus dana offerings. 6 Day Retreat – Please select the rate that you can contribute for this retreat.*Please note that the Cloud Mountain Cancellation & Housing Policies remain the same & are not based on the price you choose. Click here for more information about tiered fees. Subsidized Rate – $420 Plus dana offerings. Sustaining Rate – $510 Plus dana offerings. Supporting Rate – $600 Plus dana offerings. Hidden7 Day Retreat – Please select the rate that you can contribute for this retreat.*Please note that the Cloud Mountain Cancellation & Housing Policies remain the same & are not based on the price you choose. Click here for more information about tiered fees. Subsidized Rate – $490 Plus dana offerings. Sustaining Rate – $595 Plus dana offerings. Supporting Rate – $700 Plus dana offerings. Hidden8 Day Retreat – Please select the rate that you can contribute for this retreat.*Please note that the Cloud Mountain Cancellation & Housing Policies remain the same & are not based on the price you choose. Click here for more information about tiered fees. Subsidized Rate – $560 Plus dana offerings. Sustaining Rate – $610 Plus dana offerings. Supporting Rate – $660 Plus dana offerings. 9 Day Retreat – Please select the rate that you can contribute for this retreat.*Please note that the Cloud Mountain Cancellation & Housing Policies remain the same & are not based on the price you choose. Click here for more information about tiered fees. Subsidized Rate – $630 Plus dana offerings. Sustaining Rate – $765 Plus dana offerings. Supporting Rate – $900 Plus dana offerings. Hidden10 Day Retreat – Please select the rate that you can contribute for this retreat.*Please note that the Cloud Mountain Cancellation & Housing Policies remain the same & are not based on the price you choose. Click here for more information about tiered fees. Subsidized Rate – $700 Plus dana offerings. Sustaining Rate – $760 Plus dana offerings. Supporting Rate – $820 Plus dana offerings. 12 Day Retreat – Please select the rate that you can contribute for this retreat.*Please note that the Cloud Mountain Cancellation & Housing Policies remain the same & are not based on the price you choose. Click here for more information about tiered fees. Subsidized Rate – $840 Plus dana offerings. Sustaining Rate – $960 Plus dana offerings. Supporting Rate – $1080 Plus dana offerings. 13 Day Retreat – Please select the rate that you can contribute for this retreat.*Please note that the Cloud Mountain Cancellation & Housing Policies remain the same & are not based on the price you choose. Click here for more information about tiered fees. Subsidized Rate – $910 Plus dana offerings. Sustaining Rate – $1105 Plus dana offerings. Supporting Rate – $1300 Plus dana offerings. Hidden14 Day Retreat – Please select the rate that you can contribute for this retreat.*Please note that the Cloud Mountain Cancellation & Housing Policies remain the same & are not based on the price you choose. Click here for more information about tiered fees. Subsidized Rate – $980 Plus dana offerings. Sustaining Rate – $1120 Plus dana offerings. Supporting Rate – $1260 Plus dana offerings. Hidden15 Day Retreat – Please select the rate that you can contribute for this retreat.*Please note that the Cloud Mountain Cancellation & Housing Policies remain the same & are not based on the price you choose. Click here for more information about tiered fees. Subsidized Rate – $1 Plus dana offerings. Sustaining Rate – $2 Plus dana offerings. Supporting Rate – $3Plus dana offerings. Hidden21 Day Retreat – Please select the rate that you can contribute for this retreat.*Please note that the Cloud Mountain Cancellation & Housing Policies remain the same & are not based on the price you choose. Click here for more information about tiered fees. Subsidized Rate – $1470 Plus dana offerings. Sustaining Rate – $1680 Plus dana offerings. Supporting Rate – $1890 Plus dana offerings. Hidden27 Day Retreat – Please select the rate that you can contribute for this retreat.*Please note that the Cloud Mountain Cancellation & Housing Policies remain the same & are not based on the price you choose. Click here for more information about tiered fees. Subsidized Rate – $0000 Plus dana offerings. Sustaining Rate – $0000 Plus dana offerings. Supporting Rate – $0000 Plus dana offerings. Hidden28 Day Retreat – Please select the rate that you can contribute for this retreat.*Please note that the Cloud Mountain Cancellation & Housing Policies remain the same & are not based on the price you choose. Click here for more information about tiered fees. Subsidized Rate – $2000 Plus dana offerings. Sustaining Rate – $2250 Plus dana offerings. Supporting Rate – $2500 Plus dana offerings. This is an All Donation Retreat $100 non-refundable commitment fee Plus dana offerings There is no set fee to attend, but we ask each retreatant for a non-refundable $100 commitment fee.No Fee Retreat – There is no fee to attend this event but please fill out the registration form. 0.00 There is no fee to attend this event but please fill out the registration form. 0.00 Please see the Retreat Information page for details. External Registration This is a young adult retreat with an attendance fee of $250.00 Young Adult Retreat $250.00 This is a young adult retreat with an attendance fee of $250.00* This retreat is monastic led.* This retreat is suitable for beginners.* Experience requirements are in place for this retreat.* This retreat is for ages 18-35.* This retreat is for self-identified women.* This retreat requires an initial $500.00 deposit. This deposit will be put towards the tiered rate you have chosen. Any remaining balance will be charged on the due date posted in the retreat description. * This retreat requires an initial $1000.00 deposit. This deposit will be put towards the tiered rate you have chosen. Any remaining balance will be charged on the due date posted in the retreat description. * This retreat has special requirements. Please check the retreat listing for more info.HiddenWORK PARTY REGISTRATIONWhat is your preference for volunteer tasks?* Indoors Outdoors Wherever I’m most needed Which day(s) do you wish to attend?* Saturday Sunday Both For which nights do you need housing?* Friday night Saturday night None Both For which meals will you join in? Saturday breakfast Saturday lunch Saturday dinner Sunday breakfast Sunday lunch None If you have not already filled out our “Dana Hands” survey, we’d be grateful if you could follow this link to do so before the work weekend: https://forms.gle/a4HzMg8y3tHNUxjPA CONTACT INFORMATIONName* First Middle Last Email* Please note that this is the email to which we’ll send all retreat-related correspondence.Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country Cell Phone*Alternate PhoneDo you prefer email or text for retreat-related communications? (Please be aware that most communications are emailed by default.)* Email Text Do you prefer email or text for work party-related communications? (Please be aware that most communications are emailed by default.)* Email Text Occupation* Age*Gender*Please indicate your gender identity. Male Female How did you hear about this retreat?*Check all that apply. Family member Friend Cloud Mountain website Cloud Mountain mailed flyer Cloud Mountain email Teacher Sangha Internet Search Attended a prior retreat with this teacher(s) Other How did you hear about this work party?*Check all that apply. Family member Friend Cloud Mountain website Cloud Mountain mailed flyer Cloud Mountain email Teacher Sangha Internet Search Attended a prior retreat with this teacher(s) Other HiddenHow heard about us (copy all checkboxes for DB) If other, please describe:* EMERGENCY CONTACT INFORMATIONMedical Doctor* Doctor Phone Number*Emergency Contact Name* The contact you provide should be someone who is able to physically connect with and check on you.Emergency Contact Phone Number*PERSONAL INFORMATIONThis information helps us make your retreat experience as smooth as possible. We do our best to accommodate special medical needs. HEALTH INFORMATION: Cloud Mountain is located in a rural area and there are no physicians or health care professionals on staff.Do you snore loudly?* Yes No Do you use a CPAP?* Yes No On a scale of 0 – 10, with 10 signifying excellent ability and 0 signifying complete inability, please rate your ability to walk long distances (500 feet or more at one time) several times per day.10 – excellent ability9876543210 – complete inabilityOn a scale of 0 – 10, with 10 signifying excellent ability and 0 signifying complete inability, please rate your ability to walk uphill several times per day.10 – excellent ability9876543210 – complete inabilityDuring the warmer months, are you open to camping? Yes No Do you have any disability issues?*Do you have any issues, including but not limited to physical health and mobility, that may impact your housing, yogi jobs or overall ability to fully participate in the entire retreat? This information will help us in assigning you a room and ensuring you a comfortable retreat experience. Yes No Do you have any disability issues?*Do you have any issues, including but not limited to physical health and mobility, that may impact your housing, volunteer jobs or overall ability to fully participate in the work weekend? This information will help us in assigning you a room and ensuring you a comfortable volunteer experience. Yes No Please explain your situation.*Do you have any food allergies or dietary restrictions?*We serve a lacto-ovo vegetarian menu (contains dairy and eggs.) Yes No Diet Details*If you have a severe food allergy please indicate this below. Dairy-free Wheat-free Vegan Peanut Allergy Other HiddenFood Restrictions (copy all checkboxes for DB) If other, please describe:* Additional DetailsUse this box to alert us to severe food allergies, including the severity of your reaction, or additional dietary restrictions.In regards to your dietary restrictions, please note that we do serve a vegetarian diet. We use tofu, beans, and/or lentils as a protein source in many dishes. For lunch, we serve a grain (usually rice), a main course (such as dal, or tofu, or tempeh), a vegetable, and salad. For dinner, we serve soup and artisan breads. An ingredients list will be presented with all prepared meals. We also keep a stocked snack table, available at all times to retreatants, which contains fruit (apples, oranges, bananas), whole-grain crackers, rice cakes, bread, peanut butter, and jam. We do offer non-dairy, non-wheat, and vegan options when people request, and also make non-gluten, non-wheat bread available. For retreatants who have dietary restrictions other than non-dairy, non-wheat, or vegan, we recommend that you bring along some supplementary food of your own to fill in with the provided food that you can eat. We offer refrigerator space, use of the microwave in the dining hall, and shelf space to those retreatants who do not fit into what we offer for dietary restrictions. We can also offer you plastic containers so that you can put aside portions of dishes that we serve during the retreat that work for your dietary needs to eat at later times when what goes out on the table won’t work for you. In the event that you are registered into the retreat, please ask the cook for directions on where & how to store your food. With the below initialed acknowledgment, I agree to take sole responsibility for ensuring that my diet at Cloud Mountain is in accordance with my allergies, health requirements and dietary preferences. I understand that it will be my responsibility to personally supplement my diet with all foods and snacks beyond the scope of the vegetarian, vegan, and wheat-free options that Cloud Mountain Retreat Center can provide. With the below initial, I also release Friends of Cloud Mountain, the owners or Cloud Mountain Retreat Center, any of the organizations officers, directors, employees, members, agents, teachers, contractors, or volunteers from liability and responsibility for any severe allergic reaction by the consumption of food that is not in accordance with my personal medical allergies and dietary restrictions. If you have any questions or concerns regarding the food that Cloud Mountain Provides during retreat, please contact us at info@cloudmountain.org or call us at 360-274-4859 or toll-free (within the United States) at 1-888-465-9118.Please check:* I confirm that I have no known food allergies OR that I have read and accept Cloud Mountain’s food allergy policy. Is this your first experience at Cloud Mountain?* Yes No BEDDINGCloud Mountain can offer those flying in from out of the area the option of renting bedding, towels and linens for a $10 rental fee. Due to limited quantities, bedding packets should be reserved as early as possible. If you are not flying in, please plan to bring your own bedding.Cloud Mountain can offer those attending work parties the option of borrowing bedding, towels and linen. Due to limited quantities, bedding packets should be reserved as early as possible.Do you wish to borrow a bedding packet?* Yes No HiddenDo you wish to rent a bedding packet?* Yes No Do you wish to rent a bedding packet?* Yes – $10.00 No – $0.00 RIDE SHARERide-sharing is a great way to simplify retreat transportation while being conscious of our impact on the environment. If you sign up for ride-share, you will receive an e-mail two weeks prior to the start of your retreat containing contact information for other participants with whom you may arrange rides.Ride-sharing is a great way to simplify retreat transportation while being conscious of our impact on the environment. If you sign up for ride-share, you will receive an e-mail prior to the start of your retreat containing contact information for other participants with whom you may arrange rides.Would you like to participate in ride-sharing?* Yes No Do you wish to:* Give Receive Either, I’m flexible One way or round trip?* one way round trip If giving, to how many?*123456789From where will you be travelling?*e.g. “Seattle, WA” or “Portland International Airport” Additional Details:MEDITATION EXPERIENCEIs this your first retreat through Cloud Mountain?* Yes No Are you brand new to meditation?* Yes, I am brand new. No, I have experience. How long have you practiced?* In what traditions?* Given the choice, would you prefer to use a chair or cushion during your retreat? Chair Cushion Either – I’m flexible PREREQUISITES FOR EXPERIENCED STUDENT RETREATSThere are experience prerequisites in place for this retreat.*Please use this field to provide the information to verify that you meet those prerequisites, including at least approximate dates, length, teacher(s) and location of previous retreats.We are setting a high bar for retreats for advanced students. In the past, the definition of an experienced or advanced student has generally been characterized by the amount of formal retreat time in which one has engaged. While time logged on the cushion can be an important aspect of experience, we do not find this measure alone to be a meaningful gauge of the quality of a student’s practice. We see an advanced student as someone who has developed a balanced practice, with sincere and diligent attention to practicing sila (ethical/moral conduct) and dana (generosity), in addition to bhavana (cultivation of mind). Sometimes yogis engage in unwholesome behaviors indicative of a need for additional development. Behavior checklist:*Please review and check all. Arriving late or leaving a retreat early without prior permission (except in the case of an emergency) Lying or manipulating to secure a single room or other personal preferences Not fulfilling yogi job commitments Not offering dana to the teacher (of money, volunteer energy, or another expression of generosity/gratitude) Not offering dana to the staff (of money, volunteer energy, or another expression of generosity/gratitude) Making demands and expressions of entitlement Please review and check each item of the above list so that we are sure you fully understand what is considered unwholesome behavior at an experienced/ advanced student retreat. All of these behaviors create hardship and have a corrosive effect on our collective ability to keep the Dhamma alive, available and accessible. It is our belief as a Dhamma organization that those who aspire to take their wisdom practice to deeper levels should not neglect the vital foundational practices of dana and sila. All practitioners are welcome on any of our open retreats. However, in order to be considered a suitable candidate for an experienced/ advanced student retreat, these new criteria are in place to create the most fertile field of practice for all who attend and to provide adequate support for the teachers and retreat center who are gifting these practice opportunities to the world. SCHOLARSHIPSWould you like to apply for a scholarship for this retreat?* Yes No Clicking yes will open the on-line scholarship application. Scholarships are awarded on the basis of financial need only and offer up to a 50% discount off the full retreat price.ONLINE SCHOLARSHIP APPLICATIONApproved scholarships for most retreats generally come in the form of a work-exchange and a reduction in the retreat fee up to a maximum of 50% of the retreat cost. (On retreats longer than 12 days, the amount will vary, so please contact the Cloud Mountain office for specific scholarship information for longer retreats.) Work-exchange duties vary and are pre-assigned. Generally they help to support kitchen operations. Work exchange duties intrude only minimally, if at all, into formal retreat sessions; most are performed during the meal breaks or during part of a walking meditation session. In cases of disability, we are happy to adjust the work-exchange responsibilities to accommodate individuals’ particular physical needs in a gentle and appropriate way. Until the status of your scholarship is clear, we will not process your payment. If we are unable to approve you for scholarship assistance for any reason, we place your materials on hold while we can contact you to see how you wish to proceed around registering. If you decide not to register under those circumstances, you will not have committed to the retreat and may easily withdraw your registration. Please disregard the payment authorization total at the bottom of the form when applying for scholarship–we will not process any charges until reviewing your application. Please respond to the following questions and briefly state the reason why it would be a financial hardship for you to attend this retreat without this financial assistance. Please answer all questions completely. Applications without sufficient information will not be considered.Scholarship Fund*From which of the following Scholarship Funds are you requesting scholarship assistance? General Scholarship Fund People of Color Scholarship Fund Young Adults Scholarship Fund Application Information*What is your monthly income? What are your approximate monthly expenses? Are you currently employed? Are you a homeowner? Describe your household (e.g., spouse/partner, housemates, etc.)? Please be detailed enough so that we can get a good sense of your financial situation.Requested Scholarship Amount We ask you to kindly request only the amount that will allow you to attend retreat. It is our wish to extend the scholarship fund to all participants in need of financial assistance, and your financial candor is appreciated in helping make this possible. Please also note that some level of personal financial contribution is asked of each individual. If you are receiving scholarship assistance from other sources, the financial aid we offer may be adjusted to accommodate for this. Scholarships are awarded in amounts between 10% and 50% of the full retreat cost. This policy varies for retreats longer than 12 days in length, so please check with the Cloud Mountain office before applying for scholarship on a longer retreat. Requested Scholarship Amount*Please select your requested scholarship amount below: 10% of the full retreat cost 25% of the full retreat cost 50% of the full retreat cost WORK EXCHANGE PROGRAM REQUIREMENTSBecause the work-exchange is an important component of each retreat we are asking you to review and check each item of the below list of conditions and agreements. These tasks are a vital piece of service to the retreat participants, and we’d like them to be offered with a generous heart and enthusiastic spirit. We ask you to agree to each of the below points so that we are sure you fully understand what is expected and needed at each stage of the retreat service process.Work Conditions*Please review and check all: I understand that my service is a vital component of the smooth functioning of the retreat and that if I do not meet the following expectations I may be ineligible to receive future scholarship assistance. I understand that I need to be at the training/orientation given by the staff, and I agree to arrive at the retreat center in time to be present at the 2:00 pm training. (Remember that traffic is often heavy on Friday evenings and may require additional driving time.) I agree to check-in with the staff again at 3:30 pm on Friday evening the first night to see if my help is needed for the evening chores. I agree to stay through the final clean-up on the last day of the retreat, and before leaving check with the staff to see if I can be of any further assistance before I leave the center. DONATIONSWould you like to offer a donation to Friends of Cloud Mountain at this time?*Friends of Cloud Mountain is a 501 (c)(3) non-profit organization. Your contribution is fully tax deductible to the extent allowed by law. Yes No What program would you like to designate your donation to?* General Donations Nuns Initiative Sleeping Lodge Fund Accessible Housing Fund Meal Dana Staff Dana People of Color Scholarship Fund Young Adults Scholarship Fund (ages 18-35) Teacher Relief Fund Which meals would you like to offer Dana for?* Breakfast – $100.00 Lunch/Brunch – $125.00 Dinner – $75.00 Full Day – $300.00 Would you like to offer meal dana anonymously?* Yes No How would you like your meal dana dedication to read?If you do not wish to provide a special dedication, we will use one of our standard dedications. Depending on whether the offering is anonymous or not, the dedication board would read, “This meal has been offered by Jane/John Doe,” or, “This meal has been offered by an anonymous friend (present)/(not present) on this retreat.” In this case, please leave this field blank.On what day of the retreat would you like to offer meal dana? MM slash DD slash YYYY If you have no specific date in mind, please leave this field blank.What amount would you like to give to Cloud Mountain today?* $50 $75 $100 $250 $500 Other Other donation amount:* HiddenDonation Amounthidden on form but appears on PDF RETREAT ATTENDANCE POLICY(Please note: Non-refundable portions of retreat fees are also non-transferable to other individuals or retreats) Attendance for the full length of the retreat is required, including timely arrival, timely departure and full participation in work meditations. These are extremely important areas for maintaining the integrity of the retreat as a whole and for enabling Cloud Mountain to continue to offer retreats that are grounded in the tradition of a cooperative and interdependent structure. Late arrivals and early departure requests are only granted under exceptional circumstances. Any exception request to the policy to arrive late, depart early or participate in work meditations needs to made and approved by both the retreat center and the teacher(s) prior to registering into the retreat. Your space on the retreat may be withdrawn and a cancellation issued (with the appropriate cancellation fee withheld) if you discover after registering that you cannot attend the entire retreat. These areas of maintaining the integrity of the retreat environment are of such strong concern to us that an individual’s continued retreat privileges are contingent upon respecting and abiding by these expectations. A first instance of non-compliance in any of these areas will result in our sending a warning letter. A second instance will result in a one-year suspension of retreat privileges. “No shows” – those who do not alert us that they will not be attending the retreat – will not be registered for future retreats. We see these as ethical breaches; each retreatant has given their word in advance that they will abide by these expectations. Breaking these promises can be viewed as both false speech and taking what is not offered. In instances where the non-compliance is egregious, we retain the right to withdraw retreat privileges permanently. CANCELLATION POLICYSpaces on retreats are not transferable to other individuals. Non-refundable portions of retreat fees are also non-transferable to other individuals or retreats. Regretfully, we do not offer free transfers between retreats. Please see the cancellation fee schedule below. To request an exception to the cancellation policy, please provide a detailed explanation in an e-mail and send to info@cloudmountain.org. Exceptions will be considered for personal & family medical emergencies only. Requests for exceptions must be made within two weeks of the cancellation. CANCELLATION FEE SCHEDULE: Cancellation policy for all retreats less than 5 days in length: The retreat fee, less a $50 cancellation fee, will be fully refunded if Friends of Cloud Mountain is notified more than 6 months prior to the start of the retreat. The retreat fee, less a $100 cancellation fee, will be fully refunded if Friends of Cloud Mountain is notified 6 or more weeks prior to the start of the retreat. Half of the retreat fee will be forfeited if FOCM is notified between 2 to 6 weeks prior to the retreat. Cancellation policy for all retreats 5 – 12 days in length: The retreat fee, less a $75 cancellation fee, will be fully refunded if Friends of Cloud Mountain is notified more than 6 months prior to the start of the retreat. The retreat fee, less a $150 cancellation fee, will be fully refunded if Friends of Cloud Mountain is notified 6 or more weeks prior to the retreat. Half of the retreat fee will be forfeited if FOCM is notified between 2 to 6 weeks prior to the retreat. The full amount of the retreat fee will be forfeited if FOCM is notified less than 2 weeks prior to the retreat. Cancellation policy for retreats 12 days or longer but less than 27 days: With notification to FOCM more than 6 months prior, you will receive a full refund, less the cancellation fee of $100. With notification 4 – 6 months prior, the fee for cancellation is $450. With notification 1 – 4 months prior, the fee for cancellation is $750. With notification less than 1 month prior to the start date of the retreat, the full amount of the retreat fee is forfeited. Cancellation policy for retreats that are 27 days or longer: With notification to FOCM more than 6 months prior, you will receive a full refund, less the cancellation fee of $150. With notification 4 – 6 months prior, the fee for cancellation is $600. With notification 1 – 4 months prior, the fee for cancellation is $900. With notification less than 1 month prior, the full amount of the retreat fee is forfeited. Spaces on retreats are not transferable to other individuals. Non-refundable portions of retreat fees are also non-transferable to other individuals or retreats. Regretfully, we do not offer free transfers between retreats. To request an exception to the cancellation policy, please provide a detailed explanation in an e-mail and send to info@cloudmountain.org. Exceptions will be considered for personal & family medical emergencies only. Requests for exceptions must be made within two weeks of the cancellation. CANCELLATION FEE SCHEDULE: The retreat fee, less a $100 cancellation fee, will be fully refunded if Friends of Cloud Mountain is notified 6 or more weeks prior to the start of the retreat. Half of the retreat fee will be forfeited if FOCM is notified between 2 to 6 weeks prior to the retreat. The full amount of the retreat fee will be forfeited if FOCM is notified less than 2 weeks prior to the retreat. Please check:* I acknowledge that I have read, understand and agree to the Retreat Attendance Policy / Cancellation Policy. PAYMENT SUMMARYPlease review this information before submitting your form. Retreat Choice You have chosen a Supported Self-Retreat.Length of stay:daysRetreat Cost $0.00 HiddenRetreat Costappears on PDFBedding Packet Rental Fee $0.00 Donation Amount $0.00 Balance Due (after $500 Initial Deposit) Price: $0.00 An initial deposit of $500 will be charged at the time of registration. Any remaining balance will be charged on the due date posted in the retreat description.Balance Due (after $1000 Initial Deposit) Price: $0.00 An initial deposit of $1000 will be charged at the time of registration. Any remaining balance will be charged on the due date posted in the retreat description.HiddenDonation Amountdatabase use AND appears on PDFHiddenBalance Duedatabase use / appears on PDFRequested Scholarship Amount Price: $0.00 TOTAL PAYABLETotal Amount Authorized: $0.00 Includes the cost of your retreat (or initial deposit) and any donations offered. Any remaining balance will be charged on the due date posted in the retreat description.HiddenCalculated TotalThis hidden field copies the total amount. Payment Method is bypassed if this field = 0.00 (no fee retreat + no donation)PAYMENT METHODOnline registration is through credit or debit card (Visa or Mastercard only). To register by check or money order, please print out the form summary that will be emailed to you after submission and mail it in along with payment to the Cloud Mountain office. If you choose to pay by mail, your space will be held for 10 business days from receipt of your online form to allow your mailed payment to reach us. After 10 business days your space will be released if your payment has not arrived. If you are joining the waitlist for a retreat, you do not need to provide credit card payment information or a check. Instead, select the Pay By Mail option to submit your form to us without payment information at this time.Select payment method:* Pay Online Pay by Mail CREDIT CARD INFORMATIONAuthorization* I authorize Cloud Mountain to process the payment of the amount above. Any remaining balance will be charged on the due date posted in the retreat description. Credit Card* MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name Billing Address* Same as above 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 FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country HiddenSection BreakDo you wish to receive Cloud Mountain’s e-newsletters and occasional retreat updates?* Yes No Cloud Mountain never sells or shares your personal data, with the sole exception of providing your contact information to the teacher(s) leading your retreat. Other CommentsAfter submitting this registration form, a summary will be sent to your email address. Please print out the form and send along with your check or money order to: Cloud Mountain Retreat Center, 373 Agren Road, Castle Rock, WA 98611. NameThis field is for validation purposes and should be left unchanged.