SMART CE Retreat Registration Form

What is your full name? *

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

What Is Your Place of Employment? *

What Population Do You Work With? *

*Optional* What are your preferred pronouns?

T-Shirt Size (Unisex) *

Do you have any dietary restrictions? If so please explain...

Do you have any allergies that we would need to be aware of? (Food, animals, outdoors, etc.)

Do you have an accommodation preference? (Female, Male, Co-Ed, No-Preference) *

Do you request to be roomed with any other guest at the SMART CE Retreat? (If yes please specify)

Please Include an Emergency Contact (First/Last Name and Phone Number) *

The SMART CE Retreat will take place on the grounds of Bradford Woods. Attendees will have access to many nature trails and activities. There will be multiple event spaces utilized during the event, requiring transitioning between spaces during the event. Participants should be aware of the risks associated with the retreat and agree to not hold SMART CEUs Hub, LLC or any of its affiliates liable in the event of injuries, accidents, or death. Do you understand the risks associated with attendance? *

I Agree

I have read the Bradford Woods policies including the alcohol policy. I agree to comply with these policies during my time at the SMART CE Retreat. *

I Agree

I agree to allow SMART CEUs Hub, LLC to use any video or photography from the event on the website, newsletter, social media, or other related outlets. *

I Agree

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