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Journey to Secure LIVE - July 7-11, 2023 - Registration

This could be one of our presenters, an assistant, or one of our promoters. If there's no one in particular, please write "no"

Contact Information

As shown on your passport
Please use the email address you'll want us to use to communicate with you.
Please include country code and indicate both numbers if they are different.
We need this to invite you to the Graduates FB group after the retreat.
We need this to invite you to the Graduates FB group after the retreat

Additional Information

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City, State/Province, Country
Tell us more about the heritage / background that matters most to you.
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City, State/Province, Country
Name, Phone and Email

Tuition

The final price will include an additional 3% to cover fees from our payment processor.  If you'd like to use an alternative payment method (like Zelle) to avoid the fees, please use THIS LINK for payment options and choose the "alternative payment method" option below.
If you received a discount code for your community, from a facilitator, assistant, or promoter, this is the place to enter it

Accommodations

Indoor accommodations include shared rooms with twin sized beds and all bedding provided, a few queen bed upgrades (for an additional $250), and a couple of semi-private rooms for an additional $300.

If you would like an upgrade, please indicate your preference below and you will be added to a wait list.  We will know more about availability of those options closer to the training.

If you would like to camp but don't want to bring your own tent, there are some larger shared tents (you provide your own bedding) and one shared tent where bedding will be provided (first come, first served).

You are also welcome to camp with your own tent and bedding or car camp in a small vehicle or van.  If you are planning to bring an RV or trailer you MUST check with us first to see if the size of can be accommodated.

** Please note, If you choose a camping or car/RV/trailer camping option as your first choice, we will NOT reserve other accommodations for you.

Please choose as many as you would like.  If you choose a camping, car camping, or RV/trailer option, we will NOT reserve other accommodations for you.
1st choice
2nd choice
3rd choice
Not interested
Please choose as many as you would like.  If one of these options opens up for you, we will let you know closer to the training and any additional fee will be added to your balance at that time.
Share the names of anyone you know (who is going to the training) who you would like to room with, and we will do our best to accommodate you. For this training it is preferred that couples and family members do not stay in the same room.
If you are upgrading to a private room or larger bed to share with a partner, please tell us their name.
Please include any special needs.  Also please let us know if you snore loudly.

Health

Check all that apply

Tribal Connections

Final Pieces

Release of Liability

Exquisite Love LLC - Acknowledgement and Agreement for Assumption of Risk, Waiver, Release, and Consent for Participation in Exquisite Love LLC events

In consideration of the benefits of participation in Exquisite Love LLC events, and Exquisite Love LLC-affiliated events, I enter into this agreement and hereby acknowledge and agree as follows:

I. Definitions: ”Activities" shall mean all programs, classes, training and instructional sessions, events, and exercises offered by Exquisite Love LLC, Philippe Lewis or any other entity, organization, or individual in conjunction with Exquisite Love LLC, Philippe Lewis. “The Released Parties” shall mean Exquisite Love LLC, Philippe Lewis or any other entity, organization, or individual in conjunction with Exquisite Love LLC, Philippe Lewis. "Use of the Facilities" shall mean the presence on or admission to the premises or site where the Activities occur (whether indoors or outdoors) for participation, observation, instructional or any other purpose, use of the equipment, or any other property supplied by Exquisite Love LLC, Philippe Lewis or any other  individual acting in conjunction with Exquisite Love LLC.

II. Assumption of Risk: I acknowledge and understand that my participation in the Activities or Use of the Facilities will require varying degrees of physical exercise, contact with other persons, and exposure to various conditions of the Facilities.   I understand that such exercise, contact and exposure inherently carry the risk of serious injury and damage to my person or property, including without limitation, loss, death, or disability. I am aware that the usual risks, hazards, and dangers of injury, death, or disability, and loss increase when the activity takes place outdoors or when I or others consume intoxicating substances. I acknowledge that my participation in the Activities is strictly voluntary, and I acknowledge that am in good health and physical condition. In spite of the risks and dangers, I voluntarily assume any and all risks, known or unknown,anticipated or not, including but not limited to risks as listed above, related to participation in the Activities and Use of the Facilities.   As such, I understand and agree that The Released Parties shall not be liable for any injury, loss or claim, including without limitation, personal, bodily, or mental injury, death, disability, economic loss, property damage, or any other damage suffered by me in connection with my participation in the Activities or Use of the Facilities, whether resulting from the acts, negligent or otherwise, of The Released Parties or anyone else's participation in the Activities or Use of the Facilities.

III. Waiver & Release: I  hereby agree, on behalf of myself and my next of kin, heirs and representatives, to release and forever discharge, and promise not to sue, The Released Parties from any and all claims, actions, damages, liability, costs, expenses, and attorney’s fees which are related to, arise out of, or are in any way connected to my participation in the Activities or Use of the Facilities, whether or not the same are caused by the acts or omissions, negligence or otherwise, of any Released Parties  or anyone else participating in the Activities or Use of the Facilities. By this agreement, it is my intention to surrender and waive any rights to sue or exercise any legal right to seek damages from Exquisite Love LLC, Philippe Lewis or any other entity, organization, or individual in conjunction with Exquisite Love LLC, Philippe Lewis.  

IV.  Pay Costs for My Own Misconduct: I agree to defend, indemnify, hold harmless and protect the Released Parties  from and against any and all claims by another person against a Released Party, including payment of attorney’s fees, which are the result of my own alleged negligence or affirmative misconduct during or arising out of my participation in this Activity, including travel to and from or before, during or after the Activity. If any Released Party incurs any of these types of expenses, I agree to reimburse the said party on demand.

V.  Medical Condition: Persons with any known or suspected medical conditions should consult first with their doctor before engaging in the Activities, and before using any Facilities and should not engage in the Activities or use the Facilities if subject to any medical condition that might impact their ability to safely do so.  


VI.  Acknowledgements: I acknowledge that I and others may be under the influence and therefore especially susceptible to causing or contributing to incidents, or incurring incidents or injuries of various kind. I acknowledge that if any pools or water features are present there shall be NO JUMPING OR DIVING INTO POOLS ALLOWED WHATSOEVER and no running, rough play or horseplay of any kind is appropriate at any time.  I understand the Facilities may have various potential hazards, including stairs, uneven walking surfaces, dimly lit or non-lighted areas, steep hillside and decks and balconies and associated risks. I acknowledge that I DO NOT REQUEST OR NEED ANY FURTHER WARNINGS OR CAUTIONS about known or unknown, obvious or hidden hazards or dangers that may be present at the Location and that I will take responsibility for my own safety, and WILLINGLY ASSUME ALL RISKS related to the Activity or my presence at the Location.

VII.  Miscellaneous:
(a) This Agreement shall be governed by and construed under the laws of the State of California, U.S.A.
(b) This Agreement shall be effective indefinitely and shall apply to all contemporaneous agents, representatives, officers, directors, principals, successors, affiliates. subsidiaries, employees, and all other persons acting on their behalf of any Released Parties, including but not limited to Exquisite Love LLC, Philippe Lewis, or any other entity, organization, or individual assisting in the Activities or Use of the Facilities, which persons shall be express third-party beneficiaries of this Agreement

I hereby certify that I am over 18 years of age. I have carefully read the foregoing of this document and acknowledge that I understand and agree to all of the above terms and condition.

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