Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Payment options *

Please select a payment option, an invoice will be sent for payment.

Pay in full - $595

2 payments of $300

4 payments of $155

I would like to claim one of the pay what you can slots (preference given to BIPOC & Trans fam)

Acknowledgement *

I am aware of the associated risks in participating in this program. Despite these risks, I assume all known and unknown risks associated with my participation in this Activity and waive and release Tara Rainstrom and Refuge Event Space from any and all claims.

I agree

Photo release *

We will from time to time take group photos or some candid shots sparingly for the purposes of promoting the program. Please select an option below regarding your consent

Yes, I give permission to share photos with me in them

No, I do not give permission to share photos with me in them