Name(Required) First (Given Name) Last (Family Name) Your Email Address(Required) Enter Email Confirm Email Email CC: (if any) Are you attending?(Required) Yes, I’m looking forward to seeing everyone in October. Count me in! No, I will not be joining this in-person event Name Badge – Name(Required)Name Badge – AffiliationName Badge – PronounsWe invite you to have your preferred pronouns listed on your name badge they/them she/her he/him (not listed above) Please do not list Name Badge – Pronouns (custom)Hotel needed?(Required) Yes, I will be staying at Westfields Marriott, Dulles. Please provide me with room details No, I will be staying off-site and joining for the daily programming and meals Please indicate the room nights needed: Sunday, October 27 – for those traveling long distances, a limited number of hotel rooms are available for pre-arrival on Sunday Monday, October 28 Tuesday, October 29 Wednesday, October 30 – for check-out on Thursday, October 31) Onsite registration begins at 2:00 pm on Monday, October 28th with the first session starting at 4:00 pm. The last session concludes on Thursday, October 31st at noon followed by optional lunch. Towards meeting the goals of the program, we encourage full participation in the program.Flying to Dulles? Thank you for self-arranging your travel. If you would like assistance in booking travel to Dulles (IAD) airport, we are pleased to work with Covington Travel. Please contact specialist Brenda Martin at brendam@covtrav.com or (434) 220-2111. If you are unable to self-pay for your own travel expenses, travel scholarships are available (contact: ekellner@mindandlife.org).Share your name with other attendees?(Required) Please include my name on the event website as attending the program Do not include my name on the event website. However, I agree that my name can be shared directly with other confirmed attendees Do not share my name on the website, nor with other confirmed attendees. Allergies & Medical ConditionsDo you have any food allergies, medical allergies, or conditions that would be critical to know in an emergency? All information is kept confidential except as needed in an emergency, except for food allergies that will be shared with providers.Dietary PreferencesAll meals provided by Mind & Life will be vegetarian plus will include a fish option. Gluten free and vegan options will be available. If you have non-allergy dietary preferences, please indicate.AccessibilityWestfields Marriott is fully accessible with elevator access to our meeting rooms. A limited number of accessible overnight accommodations are available. If you have accessibility requirements, you will be contacted by Mind & Life staff to discuss your specific needs. I have a disability and require accommodation in order to fully participate in this event Waiver of Liability(Required)This event involves various activities to take place at Westfields Marriott. Additionally, participation includes public gatherings and meals during a time that COVID-19 may be a factor. Mind & Life considers the safety of all those onsite as our top priority. We are committed to our Duty of Care, enhancing the onsite experience and safety for everyone in attendance. That said, Mind & Life shall not be liable to the registrant for any damage to material goods, persons, or property. By attending this event, you agree to abide by and engage in safety-beneficial conduct while attending the event. I understand and agree Photography and Video Consent(Required)In order to create an historical record of this event, some of the proceedings will be photographed and filmed. By registering, you grant Mind & Life permission to use your image and spoken or written words. If you have specific concerns related to this consent, please contact ekellner@mindandlife.org prior to registering. I understand and agree Privacy Policy(Required)Mind & Life’s use of any information submitted during this registration process is governed by the terms outlined in the Mind & Life Privacy Policy. I understand and agree Cancellation Policy As this is a limited-space event, please notify ekellner@mindandlife.org if you are no longer able to attend so that your space can be offered to a waitlisted participant. Mind & Life is financially responsible to the hotel for our contracted event and we all would like to see rooms and meals fully attended. Thank you for your consideration. Is there anything further that you wish to share with us?
