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Visiting Scholar Registration

This form is for both day visitors and overnight visitors.
Business use only, visitors must be approved by the Programs Department

ONE PERSON PER REGISTRATION, unless the registration is for a couple in the same room.

* These fields are required

1 Visitor Detail

2 Select Date

3 Select Lodging Type or Day Visitor

4 Couples only - both names

COUPLES ONLY Enter the remaining guest names here.
NOTE Guest 1 is the host, person registering as per Section 1 Guest Detail.

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

5 Complete the Visitor Information

Please complete the following guest information.

Phone	Please use format 831 555 5555 to enter your phone number
Address
Address 2
City
State/Prov.
Zip/Postal
Country
Organization
Gender *
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.
Reason for Visit *	Please enter the purpose of the visit.