DEB SCHWEDHELM

NAME *

First Name

Last Name

CELL PHONE NUMBER *

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ATTENDING THE ADD-ON CHARLOTTESVILLE EXCURSION? *

Select one

Yes

No

FOR ROOM ASSIGNMENTS *

Hotel rooms will be shared, two to a room, with two beds. Please check all that are applicable, to be considered when pairing attendees in rooms.

I sometimes snore.

I am late to bed, late to rise.

I am early to bed, early to rise.

I like to talk.

I like my quiet time.

I really prefer my own room and am willing to pay an additional $75 per night.

None of the above.

TIN-TYPE PORTRAIT? *

Do you want to make your own tin-type portrait at the retreat? You will be the subject and after the image is exposed, you will go through the wet-plate collodion process of making your own tintype portrait. NOTE: An additional $50 fee (cash only) is required.

Absolutely

No thank you

Date *

MM

DD

YYYY