To assist you in filling out this form, please refer to the guidelines for complete retreat information. Registration and payment are due in full by 1pm, Wednesday, October 18th. Please mail payment to: KSC 109 Clear Creek Drive, Suite 102, Ashland OR 97520. Space is limited.

If you are applying for Work Exchange or Scholarship, please download and complete the form, and send it to KSC before the due date. 

Cancellation and refund policy: If you are unable to attend this retreat, immediately contact the retreat coordinator at retreats@kscashland.org. If you cancel your retreat by 1 pm, Wednesday, October 18th, KSC will refund your payment, minus a $30 handling fee. Cancellations received after this date will not be refunded due to KSC's obligation for the cost of your retreat reservation. 

Buckhorn Springs Retreat Registration

Name *
Name
Address *
Address
Phone *
Phone
Birth date *
Birth date
Today's Date *
Today's Date
Are you a KSC member? *
Is this your first overnight retreat at Buckhorn or with KSC? *
Are you here with a spouse, family member, or friend? *
I am *
I snore *
Emergency Contact *
Emergency Contact
Emergency Contact Day Phone *
Emergency Contact Day Phone
Emergency Contact Night Phone *
Emergency Contact Night Phone
Should we contact your healthcare provider in an emergency? *
Health Care Provider
Health Care Provider
Health Care Provider Phone
Health Care Provider Phone
Is your diet:
I need a ride: *
I can give a ride: *
I can assist in transporting materials:
Accommodations request: *
I am applying for
I understand that my registration is complete with payment of $100 *
Balance due by October 18th