Elements Alive Registration

September 5 - 7, 2025

403 Ward Rd., 4H Campground, Kelleys Island, Ohio (419) 746-2794

Registration is Easy!

Please complete this registration form and submit payment to reserve your spot.

We look forward to sharing this beautiful experience with you!

1) Participant Information

Name*

Email*

Phone Number*

Street Address

City, State, Zip

Emergency Contact & Phone

Type of Accommodation*

Shared cabin (men)

Shared cabin (women)

Tent or car camping

My own offsite lodging

Health & Wellness Information

I have medical conditions that staff should be aware of

I request mobility or accessibility accommodations

I have dietary restrictions (We will do our best to accommodate you but recommend that you supplement with your own food.)

Explanation

Payment Options (Includes meals, all scheduled events and use of facilities. Does not include ferry fare to the island. Must be 18 or older. Sorry, no pets).

Attendance with Lodging ($295/person)

Attendance without Lodging ($225/person)

I acknowledge that I am participating at my own risk and release all organizers from any liability. I agree to abide by the rules of conduct, which will be provided to me. I grant permission for photos and videos to be taken. Refund policy: 10% cancellation charge on or before August 29. No refunds after August 29. *

Comments

2) Payment Information (choose an option from below)

OPTION 1: Mobile Payment -- We accept CashApp, Venmo, and Zelle. Manually type in the account information as listed, or scan the QR code below with your device.

CashApp: $yogamichigan

Venmo: @yoga-michigan

Zelle: info@yoga-michigan.com

When submitting payment by these methods, please include a memo with the name(s) of person(s) attending and the word "Retreat." Example: "Jane & John Doe Retreat." If required for verification, the last 4 digits of the account phone number are "0333."

OPTION 2: Credit Card

Payments are processed through Zeffy, a credit card processing company for non-profits. They do not charge us, however, they will try to add a 15% fee by default at the end of your order (see screen shots below). You are not required to pay it. You may choose to contribute or not by changing the amount to "Other." Please note that the charge to your credit card will appear as being from "11 RISE," which is our IRS 501(c)3 registered non-profit account.
Payment link: https://www.zeffy.com/ticketing/elements-alive-healing-arts-and-rhythm-retreat
(Zeffy's payment screen #1)
(Zeffy's payment screen #2)

If you have problems with the registration process, please email us.

That's it! You will receive a confirmation email from us shortly.