Florence – RegistrationName* First Last Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Waiver—Release and Assumption of Risk: I hereby acknowledge that I have voluntarily applied (the “Applicant”) to Artfully Inspired Retreats, LLC, an Arizona entity (the “Operator”) and that the Operator relies in part on others to provide overnight accommodations, personal tours, and instruction. The Operator while exercising reasonable care in selecting such premises and independent contractors, does not guaranteed without limitation their suitability or performance. I understand that no refunds will be given for any part of the retreat/ tour that the Applicant chooses to opt out of. It is the Applicant’s responsibility to inform the Operator of any food allergies, sensitivities, or personal or religious food restrictions 60 days prior to trip. If the Operator is not made aware of need for special food accommodations at least 60 days prior to trip by the Applicant, the Operator cannot guarantee those needs will be met (although every effort will be made to accommodate the Applicant). I further herein acknowledge and agree to release, absolve, indemnify and hold harmless the Operator, its organizers, sponsors, shareholders, and employees from any injury or loss caused by or resulting from the leased accommodations or employment of any and all independent contractors (the “Agreement”), unless such injury or loss resulted from the gross negligence of the Operator in selecting such premises or employing such party(s). While I recognize that the Operator has made every effort to research the retreat location for its overall suitability, I understand that there are inherent risks involved with travel and that the Operator is not responsible for acts of God and political conflict that may occur at the retreat destination. This agreement shall also serve as a release and assumption of risk from my heirs, executors, administrators, and all members of my family. I have carefully read this Agreement, understand that I am releasing certain legal rights that I otherwise have and I enter into this Agreement freely and voluntarily. I understand that Operator, in accepting my application to attend, does so based on this representation. In witness whereof, this Release and Assumption of Risk is executed and presented to the Operator on [fill in the date and year and then check box that it was read and then digital signature/ type in their name] Check here if you have read and agree with these terms* YesDate* MM slash DD slash YYYY Signature (enter your name)*I have read and agree with the terms above.- - - - - - - - - Single Occupancy - $3697 & Double Occupancy - $4397$800 deposit is due at time of registration (or full payment can be submitted)Balance (after deposit) due 8/15/22 $3597 for a single and $2897 for a double Mail check to: Jennifer Vigil 839 W Moore Rd Oro Valley, AZ 85755 - - - - - - - - - For wire transfers contact Jennifer at 520.276.4424 for details.Δ
