Activate: Digital Leadership

Payment option 1 - Full Amount: We appreciate payment in full upon registration.

Payment option 2 - 20% Deposit + 15% Admin Fee: To make it possible for those who are unable to pay up front to register, we offer a deferred payment option. Please note that there is an administrative charge for this service. A 15% admin fee of the total registration amount will be added to your statement by our team after your registration is finalized. The remaining balance will be charged 30 days ahead of your program start date.

* These fields are required

1 Welcome

3 People in your group

Guest 1		First Name* Last Name* Email* Room Share Preference
Guest 1		First Name* Last Name* Email* Room Share Preference

After completing this form, emails will be sent to everyone in your group to complete their information.

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4 Participant Info

We aspire to create a community of care around each and every Hollyhock guest. Thank you for taking the time to share some details with us.

Email newsletter	Subscribe me to Hollyhock Talks emails!Enjoy special discounts, recipes, videos, podcasts, and blog posts from Hollyhock presenters and staff!
Phone *
Emergency Contact *	Include name, relationship, and phone number of an emergency contact who will not be attending with you.
Address *
Address 2
City *
State/Prov. *
Zip/Postal *
Country *
Age	under 18 18 - 24 25 - 39 40 - 54 55 - 64 65 - 74 75 +
What are your pronouns? *	She / Her / Hers He / Him / His They / Them / Theirs Other Prefer not to say
Other Pronouns
We aim to create safer environments that cater to a diverse audience. Acknowledging the significant work being done in marginalized and racialized communities, our goal is to provide a platform for these voices to be heard. Please check all that apply:	Indigenous, Aboriginal, First Nations, Metis, or Inuit Black, or of African descent Person of colour White, Caucasian 2SLGBTQIA+ Person with a visible or invisible disability Person who is neurodivergent Recent immigrant or refugee Other
Business or Organization *
If you checked "Other" please specify:
Are you sharing a room?	Yes
Room Share Preference	Hollyhock's dorm accommodations use gender-based room assignment. Our All-Gender dorm is open to all genders. If you identify as trans, non-binary, neutral, or otherwise genderqueer and have selected a twin or 3-share room, please choose the shared arrangement that is most comfortable for you. You may call us if you have any questions or concerns. 1-800-933-6339
Requested Roommate	Please indicate the name(s) of anyone you would like to share a room with.
Are you staying off-site (Commuter)?	Yes
Commuter Meals	Breakfast, Lunch, & Dinner ($115/day) Lunch & Dinner ($90.00/day) Lunch Only ($30.00/day) Your commuter package includes breakfast, lunch, and dinner. If your prefer to only have lunch and dinner, or just lunch, please check the appropriate box. Your package and pricing will be updated manually and you will get a second confirmation when we have updated your package. Please call us if you have any questions or would like a different meal arrangement: 1.800.933.6339

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5 Special Considerations & Comfort

Meal Options *	All buffet meals feature ingredients from our garden, locally sourced proteins, with a weekly oyster barbecue.
Are you:	Dairy Free Gluten Free Celiac More information about sensitivities and intolerances may be added below.
If your dietary needs are not listed above, please provide them here. *
Food Allergies & Intolerances	I have a life threatening or serious food allergy I have a food sensitivity or intolerance We are a remote island location with limited resources. For all life threatening allergies, or diets outside of what is offered please contact registration@hollyhock.ca to ascertain whether we can accommodate your needs at Hollyhock. Hollyhock routinely prepares a variety of foods so we can never completely guarantee an allergen-free food preparation environment.
If you clicked yes to "Life Threatening Allergy" please contact us directly to ascertain if we can accommodate your safety 1-800-933-6339. Please indicate your life threatening or serious food allergies here: *
If you clicked yes to "I have a food sensitivity or intolerance" please call us directly to ascertain if we can accommodate your needs +1 800 933 6339: *
How did you hear about your program? *	Hollyhock Website Hollyhock Email Online Search (e.g. Google) Program Presenter (e.g. presenter's website, email, podcast/interview) Social Media (e.g. Facebook, Instagram, Twitter) Print or Online Article, Magazine, or other Publication (e.g. Tyee, CBC, Strathcona Collective) Partner Website or Catalogue (e.g. Banyen, Explore Vancouver Island) Friend, Family, Word-of-Mouth Other Please select all that contributed to your decision to register today.
Second choice for accommodation	Tent site Shared dorm - Room with up to 6 people per room Twin - Room with 2-3 roommates Private - Private room with shared bathroom Commuter - Stay offsite and enjoy your meals on campus Private - Private room with private bathroom
Please help us ensure your comfort by sharing any special information concerning accessibility requirements or other physical, emotional, behavioral, or relational needs.	Please note we need 30 days notice if you will be bringing a registered service dog. Please contact registration@hollyhock.ca for questions about this
Have you attended Activate before? *	Yes No
This program includes peer learning and artistic practice. Are there any workshops or conversations you'd like to lead or any artistic talents you might offer - read a poem, sing a song, lead a movement session, etc.
Your LinkedIn url or website
What is your role in your business/organization? *	If you don't have a specific role please indicate that.
Which best describes the space(s) in which you do your work: *	Union Political Advocacy Digital Studio / Agency Other
Your industry *
Please share a little about your business/organization's mission and the impact you make in the world *
Please share what interests you about this program and what you are hoping to draw from the experience. *
I consent for my name, email address, and organization to be shared with fellow participants in the program. (ex: contact list, email listserv)	I consent for my name and email address to be shared with fellow participants in the program.
Terms and Conditions *	I agree that 20% of the registration fee is non-refundable and that any remaining balance will be automatically charged to the credit card on file 30 days before the eventI have read and agree to the full Terms and Conditions found here.
Media Acknowledgment *	If I do not wish for my image/likeness or voice to be recorded, I will request and sign an opt-out form during check-in and make my presenter or anyone making recordings aware of my choice.Full terms and conditions can be found here.

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6 Donate

CAD $	Support Our Work Hollyhock is a not-for-profit registered charity, and relies on philanthropic giving to operate. Each year we curate our program offerings to foster critical skills for navigating the complexities of our world, as well as space for rest and meaningful relationships across generations and geography. Every bit counts. Thank you for your generosity and for being an important part of our community. Together, we can plant the seeds of meaningful experiences for personal development and social transformation that will continue to grow for years to come. Charitable tax receipts are available for those who contribute $25 CAD or more. Donations are non-refundable.

7 Payment

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Private Cabin Oceanfront

Single w/ensuite Oceanfront

Single w/ensuite

Single w/shared bathroom

Couple w/ensuite Oceanfront

Couple w/ensuite

Couple w/shared bathroom

Twin w/ensuite oceanfront

Twin w/ensuite

Twin w/shared bathroom

Three-share w/shared bathroom

Women's Dorm

Men's Dorm

All-Gender Dorm

Tent Site Single

Tent Site Couple

Commuter

Activate: Digital Leadership

1 Welcome

2 Accommodations and Availability

Select an option*

Private Cabin Oceanfront

Single w/ensuite Oceanfront

Single w/ensuite

Single w/shared bathroom

Couple w/ensuite Oceanfront

Couple w/ensuite

Couple w/shared bathroom

Twin w/ensuite oceanfront

Twin w/ensuite

Twin w/shared bathroom

Three-share w/shared bathroom

Women's Dorm

Men's Dorm

All-Gender Dorm

Tent Site Single

Tent Site Couple

Commuter

3 People in your group

4 Participant Info

5 Special Considerations & Comfort

6 Donate

7 Payment