EmailMe Form - PAINT MOJO Art Retreat Registration

Name *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Home Phone *

### - ### - ####

Cell Phone *

### - ### - ####

Email *

ALL INCLUSIVE RETREAT FEES INCLUDE:

2 days / 2 nights Lodging ~ ALL MEALS ~ 2 Day Workshop w/ Tracy Verdugo for ONE Attendee.

Choose ONE Registration Method:

All Payments Must Be Received Within 5 days of Registration. *

MARCH ONLY MOJO SPECIAL $375.00 (Only available until 3/31/12, payment in full required)

APRIL ONLY MOJO SPECIAL $395.00 (Only available until 4/30/12, payment in full required)

MAY ONLY MOJO SPECIAL $415.00 (Only available until 5/31/12, payment in full required)

AFTER MAY 2012 REGISTRATION FEE $425.00 (payment in full required)

~ SPECIAL PAYMENT PLAN ~ $450.00 See Below for Payment Plan Details.

____________________________________________________

* * * IMPORTANT * * * PLEASE READ CAREFULLY!!!

PAYMENT PLAN DETAILS:
Available NOW through July 1, 2012 only!
$150.00 Deposit includes $25.00 non-refundable administration fee.
All Payment Plans must be paid in full by August 15, 2012.
ALL Payment Plan Registrations NOT paid in full by August 15, 2012 will be cancelled with NO refunds available.

CANCELLATION POLICY:
Due to the nature of this retreat, ie: rental of a resort premises requiring minimum occupancy and hosting an internationally recognized artist, stringent refund policies have to be set. We understand that situations can sometimes arise causing a change in plans. It is not possible for Selah Gay, Robin Gay White, Tracy Verdugo or Lotus Ranch to favor an individual situation or circumstance over another, so we must maintain a standard business policy for all, with no exceptions.

+ No refunds after September 1st, 2012
+ Cancellations before June 1st, 2012 - Full Refund (unless on payment plan...see details above)
+ Cancellations after June 1st - September 1st - Full Refund less $25.00 administration fee. (unless on payment plan...see details above)

We recommend that attendees purchase travel/holiday insurance.
____________________________________________________

Choose ONE Payment Method: *

CREDIT CARD~USE PAYPAL LINK ON SITE

PERSONAL CHECK *

CASHIERS CHECK / MONEY ORDER *

______________

PAYPAL INSTRUCTIONS:

Please use PAYPAL link on www.SelahGay.net website

Please reference MOJO RETREAT and YOUR NAME in Message Box on PayPal payment page.
______________

MAKE CHECKS PAYABLE TO:

Robin Gay White
9201 Simmons #105
Austin, Texas 78759

Please reference MOJO RETREAT and YOUR NAME in Message area of check.

* NOTE: REGISTRATION IS NOT GUARANTEED UNTIL PAYMENT IS RECEIVED AND HAS CLEARED THE BANK.

FOR FASTEST GUARANTEED REGISTRATION, USE PAYPAL.
______________

TERMS and CONDITIONS

The above link goes to http://www.selahgay.net/p/paint-mojo-terms-and-conditions.html

*

I have read and agree to the Terms and Conditions of PAINT MOJO Retreat and of LOTUS RANCH LLC listed on the above link.

MODE OF TRANSPORTATION:

DRIVING

FLYING / DRIVING

CHECK IN TIME TO RETREAT WILL BE AFTER 4:00 pm Friday, October 26, 2012

CHECK OUT TIME will be approximately 4:00 pm Sunday, October 28, 2012

If you will be arriving earlier than 4:00 pm Friday, please let us know so we can help make arrangements for you.

Selah Gay: Cell 512-228-2511

In Case of Emergency:

Name *

First Last

Phone # 1 *

### - ### - ####

Phone #2

### - ### - ####

Email *