Workshop Registration

Thank you for your interest in Esalen Institute, a leading non-profit center exploring and realizing human potential through experience, education, and research. We work toward the realization of a more just, creative, and sustainable world, seeking answers to questions unlikely to be explored by traditional universities and religions.

Important Note:
All program participants and visitors must be 18 years or older. The Esalen Institute will continue to maintain an adult-only space for our regularly scheduled programming in 2023.

Proof of Negative COVID-19 Test Result Required
Due to the nature of breathwork and at the request of faculty Stacia Butterfield, a negative COVID-19 test result is required upon arrival for participation in this workshop. For more information about this requirement, please contact Esalen Reservations at info@esalen.org or (831) 667-3000 Monday - Saturday from 9:00 a.m. - 5:00 p.m. Pacific Time.

* These fields are required

1 Welcome

3 If your registration is for two people, please enter both parties' information at the time of registration

Please enter a valid email address for each participant.

Note: All participants must be 18 years or older

If this registration is for two people, please know that the second person's name will not appear on your statement. Only the name of the person making the registration is displayed.

Guest 1		First Name* Last Name* Email* Gender*
Guest 1		First Name* Last Name* Email* Gender*

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

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4 Optional Items

5 Complete Your Information

Please provide your complete contact information. Your information will help us serve you better and will not be shared with outside parties.

Address *
Address 2
City *
State/Prov. *
Zip/Postal *
Country *
Organization
Alternate Phone	Please use format 831 555 5555 to enter your phone number
Birth Date
Gender *
Age Range *
Emergency Contact Information	Please enter the full name and phone number.
Comments or Special Requests	What do we need to know to support your additional accommodation needs? Please know we will work hard to deliver, and your request cannot be guaranteed.
Diet Request *	Please select your preferred meal option. All foods containing gluten or common allergens are labelled accordingly. We are unable to accommodate special dietary requests.
Serious Food Allergy?	Please leave blank if answer is none. This field is for serious food allergies only. All food items containing reported allergens will be labelled accordingly. If you have serious food allergies, please bring suitable items that are non-perishable.
Dietary Restrictions	Gluten Free No Soy No Garlic No Onions Select 1 or more dietary restrictions if applicable.
Senior Citizen?	over 65 yearsEsalen provides a discount for Senior Citizens over 65 years, please also select the Senior Discount item under Optional Items to receive your discount.
Is this your first time to Esalen?	Yes No
How did you hear about us?
Stay Connected	Esalen's monthly newsletterPlease add me to Esalen's monthly newsletter for the most current updates on workshop offerings and other news from Big Sur.
COVID-19 Guidelines	I have fully reviewed and accept the updated COVID-19 GuidelinesView Esalen COVID-19 Guidelines
Cancellation Policy *	I accept the cancellation policyIf you cancel, change, or reschedule your reservation, you will be charged. If you reschedule or change your reservation: ● 30 or more days prior to your arrival date, you will be charged a $75.00 Change Fee. ● 15 to 29 days prior to your arrival date, you will be charged a $150.00 Change Fee. ● 14 days or less prior to your arrival date, you will be subject to the standard cancellation policy below. If you cancel your reservation: ● 30 or more days prior to your arrival date, you will be charged a $150.00 Cancel Fee. Any remaining amount paid will be refunded. ● 15 to 29 days prior to your arrival date, you will be charged a Cancel Fee of 15% of the reservation total. Any remaining amount paid will be refunded. ● 7 to 14 days prior to your arrival date, you will be charged a Cancel Fee of 30% of the reservation total. Any remaining amount paid will be refunded. ● Less than 7 days prior to your arrival date, you will forfeit the entire reservation total and no refund will be provided.
Total Number of Guests *	Total guest number must be selected from the drop-down menu of your selected accommodation in Section 2 Choose Your Accommodations. If registering for two guests, Name and Email must be entered for both guests in Section 3.
Your Gift Matters	Esalen Institute is a 501(c)(3) non-profit organization. To give in support of the specific area of our work that resonates with you, visit esalen.org/give. Your tax-deductible gift helps advance our non-profit mission.

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6 Inclusion and Equity Survey

Please select which race and/or ethnicity you identify with *	Indigenous, Native American Black or African American Asian American, Desi-American, Pacific Islander Hispanic or Latino Multiracial, biracial Asian Middle Eastern White Other Prefer not to answer
Other (Fill in)
Income range	$31,000 or less $31,000 - $42, 000 $42, 000- $126,000 $126, 000 - $188, 000 $188,000 or more Prefer not to answer
Education	High School diploma Associates degree BA MA PhD MD JD N/A Prefer not to answer
Thank you !	We appreciate your time and support in completing this survey.

7 Payment

To reserve your space, we require a minimum deposit of 50% of the reservation total.

The full payment of the reservation’s balance is due ten days before arrival and is automatically charged to your credit card.

Sub Total	$0

Taxes	$0

50% Deposit	$0

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

Due Now	$0 $0

First Name
Last Name
Card Type
Card Number *
Card Expiration *	Month Year
Card Security Code	usually a 3 digit code on back of card

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Workshop Registration

1 Welcome

2 Choose Your Accommodations

Select an option*

Sleeping Bag Space

Bunk Bed Space

Standard Shared Space

Standard Queen Room

Standard Room Two Beds

Premium Queen Room

Premium King Room

Premium Plus King Room

Premium Wooden Yurt

Premium Wooden Yurt Two Beds

Rolf Suite

Point House

Fritz Point House

South Point House

3 If your registration is for two people, please enter both parties' information at the time of registration

4 Optional Items

5 Complete Your Information

6 Inclusion and Equity Survey

7 Payment