Women+ in Climate

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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 *
Alternative 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 physical or cognitive impairment 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 mixed 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 ($93.00/day) Lunch Only ($31.00/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 *	We are returning to buffet service in 2025. All meals feature ingredients from our garden, locally sourced proteins, with a weekly oyster barbecue.
If you said 'yes' to Restricted Diet, please indicate which options apply to you: *	Pescatarian Vegetarian Vegan Dairy Free Gluten Free We are a remote island location with limited resources. If you have any dietary needs outside what is offered here please contact registration@hollyhock.ca to ascertain whether we can accommodate your dietary requirements at Hollyhock.
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, *
Are you age 65+?	Yes
Senior 15% Discount	Type "SENIOR" in the promo code box in the Terms & Condition section to get 15% off your room charges (if you are staying on campus). Some conditions apply.
Please help us ensure your comfort by sharing any special information concerning accessibility requirements or other physical, emotional, behavioral, or relational needs.
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
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.

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6 Terms & Conditions

Terms and Conditions *	I agree that my deposit is non-refundable and that the final balance will be automatically charged to the credit card on file 30 days before the eventFull terms & conditions can be found here.
Media Acknowledgment *	If I do not wish for our 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. I otherwise consent to the use of my image/likeness or voice to be used by Hollyhock in promotional or educational materials. I understand that I will be told before any recordings commence and that Hollyhock will strive to represent all images in an honest and respectful way. I will ask for assistance if I need any support in fulfilling my wishes.

7 Donate

CAD $	Support grassroots and frontline activists to join Hollyhock is a not-for-profit registered charity, and relies on philanthropic giving to operate. Your contribution supports bursaries for frontline and equity-deserving leaders who require financial assistance for the Women+ in Climate Program. Every bit counts. Thank you for your generosity and for being an important part of our community. Charitable tax receipts are available for those who contribute $25 CAD or more. Donations are non-refundable.

8 Payment

Promo Code

Sub Total	$0

Taxes	$0

20% Deposit	$0

Pay	Choose to pay a deposit or the full amount right now.

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Women+ in Climate: Leading with Light

Women+ in Climate

1 Welcome

2 Price

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 Dorm

Tent Site Single

Tent Site Couple

Commuter

3 People in your group

4 Participant Info

5 Special Considerations & Comfort

6 Terms & Conditions

7 Donate

8 Payment