AVAILABLE FORM #2

Registration Form
New Depths Intensive Program

Attachment & Core Beliefs

(Jan 20-27, 2017)
with Susan Skye and Sarah Peyton

We're delighted you'll be joining us for Week #2 of the New Depths Intensive Program in Portland, Oregon, USA. To register, please provide the following information.

If you have any questions, please don't hesitate to contact us at newdepthsjourney@gmail.com or 503-862-9224.

Your Contact Information

First Name*

Last Name*

Address - Line 1*

Address - Line 2

City*

State or Province*

ZIP/Postal Code*

Country*

Email Address*

Phone Number*

Country CodeArea CodePhone Number

Phone Number (re-enter)*

Skype ID

Time Zone (UTC)

How did you first hear about New Depths?*

Our Program Values & Requested Commitments

The following is a list of values that we'd like our participants to resonate with:

A desire to learn about the brain research findings that relate to healing unresolved childhood pain and promoting well-being

A willingness to engage in and/or witness inner work that may involve intense emotional content

A willingness and ability to be part of a group and to speak in the group

A willingness to value both your own needs and the needs of the other members of our community

1) Do you resonate with our program values? (NOTE: If "no," the New Depths Intensive Program may not be the best way to meet your needs at this time.)*

YesNoOther

An essential component of the Intensive Program's effectiveness is the resonant, empathic community that we create during the time we spend together over the weeklong residential retreat.

For this reason, we ask that you honor the container of this sacred healing space and arrive at the retreat center no later than 5pm on the first day of each retreat, and depart from the retreat center no earlier than 1pm on the last day of each retreat.

The residential retreat dates are:

January 20-27, 2017 (Friday afternoon to Friday afternoon)

2) Are you committed to attending all days of the retreat (arriving at the retreat center by 5pm on the first day, and departing the retreat center after 1pm on the last day of the retreat)?*

YesNoOther

Your Hopes and Intentions

What are you hoping for, from your participation in the New Depths Intensive Program?

Your Background/Previous Experience

We would enjoy knowing something about your background. (Note, you don't need any experience in these areas in order to profoundly benefit from the New Depths Intensive Program.)

1) Do you have any experience with meditation or any other form of presence practice?*

YesNo

1a) IF YES, please share a few words with us about your experience.

2) Do you have any experience with Nonviolent Communcation (NVC, or Compassionate Communication)?*

Yes, I'm a CNVC Certified NVC TrainerYes, I'm an Independent NVC TrainerYes, I have experience with NVC (other than teaching NVC)No

2a) IF YES, please share a few words with us about your experience.

3) Are you familiar with the "Living Energy of Needs"?*

YesNo

4) Are you a mental health professional?*

YesI'm in training to become a mental health professionalNo

4a) What is (are) your specific field(s) and/or approach(es)?

5) Do you work in the field of personal development? (nonprofessional mental health, coach, etc.)*

YesI'm in training in the field of personal developmentNo

5a) Are you associated with any particular group(s) or modality(ies)?

6) Do you have any previous personal or professional experience with brain research and/or interpersonal neurobiology?*

YesNo

6a) IF YES, please share a few words with us about your previous experience.

7) Do you have any previous personal or professional experience with trauma and its treatment?*

YesNo

7a) IF YES, please share a few words with us about your previous experience.

8a) Have you previously participated in the FULL New Depths INTENSIVE PROGRAM (3 weeklong retreats) before?*

NoYes

8b) In which year(s) did you participate in the FULL New Depths Intensive Program?

2010-112011-122013-142015

9) Have you previously participated in any other New Depths program (BESIDES the FULL Intensive Program)? If yes, which one(s)?

Your Preferences

Collecting this information will help us to make the retreat experience as comfortable and supportive as possible for you.

1) What kind of lodging arrangement would you like?*

Private RoomRoommate (I have one already)Roommate (please assign one for me)Local Commute (by special permission only, commute must be less than 20 minutes)

1a) If you already have a roommate, please enter their name here:

2) What is your gender?*

FemaleMaleOther

3) Please let us know about any special room needs you have.

Fragrance-freeIn-room internet access (NOTE: This amenity has extremely limited availablity, which we would like to reserve for those whose frequent daily access to the internet has a direct impact on their livelihood. 24-7 wireless internet access is available to all in the common areas.)Other

4) How do you plan to travel to the residential retreats (located in Eagle Creek, Oregon, USA)?

By airplane (into Portland, Oregon, airport code = PDX)By train (into Portland, Oregon)By car (directly to the Collins Retreat Center in Eagle Creek, Oregon)By local rental carNot sure yet

5) Would you like to participate in the airport shuttle pool, that would reduce your shuttle costs by about 50% (from $60 to $75 down to $30 to $35)? (If you say "yes" or "not sure yet," we'll contact you about 4 weeks before each retreat to get your flight information. About 1 week before each retreat we'll send you a draft arrival shuttle schedule, and you can commit at that time to participating in the arrival shuttle or not. Departure shuttles are organized during the retreat.)

YesYes-wheelchair accessibleNoNot sure yet

Payment

1) Are you registering with others? (If you register with one or more other people, you'll each receive a $100 discount.)**

YesMaybeNo

1a) How many other people are you registering with?

1b) If you are registering with other(s), please provide their name(s) here.

** NOTE: Multiple person discounts apply when all members of your group identify each other on your registration form, and submit your registration forms and make your deposit payments within 14 days of each other.

2) To pay your $300 registration deposit, which method of payment do you prefer?*

By checkPay online by credit/debit card (please add $10 processing fee = $310.00)Other

After August 10, 2016 payment in full is due with your registration. After you submit your application, on the next page you'll find a link you can click to pay your program fees with your credit or debit card.

Terms and Policies

1) DEPOSIT TERMS: A $300 nonrefundable registration deposit must accompany your application. You will receive a confirmation e-mail and balance payment schedule when you are accepted into the program. (If you are not accepted, your deposit will be refunded in full.) Once you have been accepted into the program, your registration deposit is non-refundable.*

I have read and accepted the Deposit Terms.

2) TRANSFER, CANCELLATION, AND REFUND POLICIES: If you cancel 35 or more days before the program starts *and* we are able to fill your place in the program with another paying participant, you'll receive a full refund, minus your nonrefundable $300 registration deposit and any processing fees. You may transfer your discounts and payments to the next retreat week one time, with the following fees: Up to 35 days before program start date: 15% tuition transfer fee, no room/board cancellation fee; 20-34 days before program start: 15% tuition transfer fee, $50 room/board cancellation fee; less than 20 days before program start: 15% tuition transfer fee, 100% room/board cancellation fee. Twenty (20) or more days before the program start date you may transfer 100% of your registration fees and applicable discounts to another participant if that person is accepted into the program, for a $150 administrative fee. Refunds are not available if you cancel after the start of your retreat week, if you do not show up, or if you leave the retreat early.*

I have read and accepted the Transfer, Cancellation, and Refund Policies.

3) Is there anything else you'd like us to know?

After you submit your application, on the next page you'll find a link you can click to pay your $310 registration deposit ($300 plus $10 processing fees) with your credit or debit card. Your confirmation email will also include a payment link. Your application is not complete until we receive your payment.

Once we receive your registration and payment, your completed application will be processed within 5-7 business days, and we will contact you by email to provide you with the next steps.

Questions? Please included them in #3 immediately above.

Warmly,

Susan and Sarah
New Depths

To complete your application, please mail your check or money order (payable to Sarah Peyton) with your retreat dates in the memo line in the amount of $300.00 US to:

     Sarah Peyton
     New Depths
   2600 NW Madrona Street
     Vancouver, WA 98665

Once we receive your Registration Deposit, we'll send you an email confirmation with your completed application submission date (based on your check postmark date) and the tuition discounts that will apply for you.

Your completed application will be processed within 5-7 business days. When you're accepted into the program we'll contact you by email to provide you with the next steps.

Questions? Please include them in #3 immediately above.

Warmly,

Susan and Sarah
New Depths

For security, please enter the contents of the field below.*

Are you registering for Retreat Week #2 (January 20-27, 2017)?

January 20-27