SJW Attendee Questionaire

Please add: registration@submissivejourneyweekend.com to your address book so that emails regarding your application don’t end up in your SPAM folder.

Please answer ALL questions.

Legal Name:*
Badge Name:*
E-mail:*
Do you prefer your class handouts:*
How would you like to pay?*
Amount to Pay Now (connects to PayPal)*
 $ 


FOOD PREFERENCES

Please list any medical dietary restrictions.
Do you eat meat?*
Are you vegetarian?
Are you vegan?
Do you eat milk, cheese, and other diary?*
Do you eat eggs/products containing eggs?*


SLEEPING ARRANGEMENTS

All rooms are shared rooms with at least one other person. There are queen beds to share and some single bunk beds.

Do you snore?*
Can you sleep with a snorer?*
Do you sleep with a CPAP Machine?*
Can you sleep in a room with a CPAP Machine?*
Do you need a light on to sleep?*
Can you sleep with a light on?*
Do you need a TV or radio on to sleep?*
Can you sleep with a TV or radio on?*
Do you usually go to bed before 10 pm?*
Can you sleep in a single bunk bed?*
Can you sleep in a top bunk?*


MEDICAL INFORMATION

List any physical limitations you may have (there are stairs at the cabin).
List any mental health issues (this is confidential).
List any medication you current take (remember to bring them)
List any non-food allergies
Are you asthmatic?
If you have need of an inhaler or epipen where do you keep it?


EMERGENCY CONTACT INFO

Legal Name of Emergency Contact:*
Relationship to Emergency Contact*
Phone number of emergency contact*
-
Does your contact know you will be in Tennessee ?*
Does your contact know you will be at an alternative lifestyle event?*


Legal Name of 2nd Emergency Contact:
Relationship to 2nd Emergency Contact:
Phone number of 2nd emergency contact
-
Does your 2nd contact know you will be in Tennessee ?
Does your 2nd contact know you will be at an alternative lifestyle event?


Anything else you need to tell us?
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