“Where Amazing Experiences Happen”

Newfield Network

October 24 - 26, 2014

Welcome to The Nature Place registration.

Use this form to register for Program Coach Retreat (PCR).

After completing, please email back to: or fax to: 719.748.3186.

Even if you've attended a Newfield Network program before, you will still need to register for this event. Please fill in all questions in red.

Participant Registration Form

First Name:
Middle Name or Initial:
Last Name:
Contact Phone:
Email:
Street Address:
City:
State:

Postal Code:
Country:

Cell Phone (only to be used on travel days if necessary):
Additional Address Information if needed:

Guest reservations are for double or single (limited availability) occupancy.

I have a roommate selected:(Yes or No)

Let us know who it is and we will do our best to pair you together.
Roommate's First Name:

Roommate's Last Name:

Please have The Nature Place select my roommate, my gender is:(Male or Female)

If you require single occupancy see the Newfield Network FAQs on our web site for more information.

If you plan on staying off-site, please let us know.

Where will you stay:

Please put your initials here:

Special dietary meals and food allergies

The Nature Place offers 4 choices for those with special dietary requirements. An additional meal charge of $3 per Lunch and $5 per Dinner (no extra charge for Breakfast) will be applied for those who choose this option. If you select any special diets, then all of your meals will be prepared from our special dietary menu. The additional charge will only be applied once to each meal, even if you have chosen more than one special dietary request. Guests are always encouraged to bring any special dietary foods they may need.

Please put a mark next to each special meal type you would like.

Vegan:

Vegetarian:

Gluten free:

Dairy free:

Do you have any food allergies? Please list in detail, so our chefs can do their best in accommodating your needs.

Tell us about your food allergy or special dietary requirements:

Costs per person for your stay at The Nature Place

All guests are registered for meals from Dinner at 6:30 PM on Sunday, October 26, 2014 and ending with a sack Lunch on Friday, October 31, 2014.

Description of service / Total Cost
Single occupancy. All meals, snacks, room, facility charges and taxes. (limited availability) / $458.71
Double occupancy. All meals, snacks, room, facility charges and taxes. / $375.59
Special dietary meals and Single occupancy. All meals, snacks, room, facility charges and taxes. (limited availability) / $475.33
Special dietary meals and Double occupancy. All meals, snacks, room, facility charges and taxes. / $392.21

For any other special costs or requirements please contact us at:

Once your registration form is received, The Nature Place will send you an invoice with payment instructions. Please have your registration complete by October 10, 2014.

Photo release

The Nature Place occasionally photographs or videos our guests and activities in a public setting for promotional and educational purposes. If you object to the use of photos or video for this purpose, let us know.

If you do not want us to use your picture or video put a mark here:

The Nature Place

Conference and Education Center

2000 Old Stage Road

Florissant, CO 80816 USA

Phone 719.748.3475, Fax 719.748.3186

Mailing address: PO Box 167

Florissant, CO 80816 USA