Online Registration

Date

First and Last Names

Street Address

City, State, Zip Code

E-mail address (for registration confirmation)

Day Phone (area code first)

Cell/Mobile Phone

Use this section if you are paying your $100 USD non-refundable reservation fee: you may use a credit or debit card.

Visa

MasterCard

Discover

Use this section if you are paying $100 USD to reserve an in-home guest room ($100 fee for all four nights of the Circle): you may use a credit or debit card. NOTE: If you have reserved a guest room and find you are unable to attend the Circle of your choice, notify KohlQuest up to three weeks before the start date of your Circle and your room fee will be refunded in full. Your Circle reservation fee must be paid before a guest room reservation will be confirmed.

Visa

MasterCard

Discover

Use this section if you are paying your remaining $500 USD registration fee: you may use a credit or debit card.

Visa

MasterCard

Discover

Use this section if you choose to pay $600 USD for both your reservation and registration fees combined : you may use a credit or debit card.

Visa

MasterCard

Discover

Enter the TOTAL payment amount you are including with this registration form

Credit or Debit Card Number

Expiration Date: Month/Year [mm/yy]

3-digit security code

Full name exactly as it appears on this credit/debit card

Select the date of the 2011 Circle of Stones gathering you are attending:

Thursday, April 28 - Sunday, May 1

Do you have any dietary restrictions or preferences (please be specific)?

What mode of transportation will you use to come to your Circle gathering?

Want to reserve an IN-HOME GUEST ROOM for four nights during your Circle stay but you don't want to use a credit or debit card? No problem. Print a copy of your completed registration form, include your check or a USPS money order for $100 USD payable to KohlQuest in the amount of $100 USD, and send both to: KohlQuest, 3271 Polk County Line Road, Rutherfordton, NC 28139. NOTE: If an additional Sunday night is needed at the end of the Circle, please notify KohlQuest immediately so we have enough time to see if such arrangements can be made. (828-288-0730 or email at support@kohlquest.com)

Protecting your personal information is a top priority at KohlQuest. All personal and financial data is protected by advanced SSL encryption. To assure safe, secure and accurate processing of every credit or debit card purchase, KohlQuest has selected PayPal for processing all online transactions. Your registration payment will appear on your statement as a transaction from PayPal KohlQuest.

IMPORTANT INFORMATION. PLEASE READ IT CAREFULLY.

By submitting this registration form, you agree to hold harmless KohlQuest, its employees, agents, freelancers, subscribers, students, or independent contractors against any and all liability, loss, or expense, including attorney fees, arising directly or indirectly from your participation in the Circle of Stones gathering. You further acknowledge that you hereby agree to forefeit and forgo ay right of claim or action whatsoever against KohlQuest, its employees, agents, freelancers, subscribers, students, or independent contractors for any reason arising from your participation in the Circle of Stones gathering.

Before submitting your registration form, be sure to print a copy for your records. Once your form has been received and payment(s) processsed, you will receive an email notification that your place in the Circle of your choice has been confirmed, including a guest room reservation confirmation if you have requested one.

Once you have completed the above form and checked to be sure all your information is correct, CLICK ONLY ONCE on the SUBMIT button below.

All of us at KohlQuest look forward
to greeting you in the Circle of Stones!


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