Soul Shepherding Institute Registration Form Name(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone(Required)Preferred Email(Required) Emergency Contact Name(Required) Emergency Contact Phone(Required)Please indicate your enrollment status in either our Certificate in Spiritual Direction (CSD) or Certificate in Coaching (CC) training programs (mark all that apply).(Required) I am not currently enrolled in the CSD or CC programs. I am in the CSD Class of 2023. I am in the CSD Class of 2024. I am in the CSD Class of 2025. I am in the CSD Class of 2026. I am in the CC Spring Class of 2023. I am in the CC Class of 2025 (starting April 2024). I am an alumni of the CSD program. I am an alumni of the CC program. Date of Retreat(Required) MM slash DD slash YYYY Location of Retreat(Required)ArizonaCaliforniaColoradoGeorgiaTexasTennessee Are you attending this retreat in-person or online?(Required) In-person Online Is this your fourth retreat, completing all four Institute Retreats? Yes, after this retreat I will have completed all four retreats. No, I still have other retreats to attend. I've already completed the retreats and am repeating this retreat. Are you a missionary who serves the persecuted church who cannot be photographed during the retreat? Yes No Food Allergies or Dietary RestrictionsRoommate Request Prefer Single Room (on a space available basis at extra cost of $250 - not available to attendees on scholarships). Yes No Interested in Ride Sharing? Yes No Would you be interested in an in person or online spiritual direction session with one of our Spiritual Directors or Coaches at an additional fee of $70? Yes No Do you have a Soul Shepherding Spiritual Director or Coach? Yes No If yes, name of Soul Shepherding Spiritual Director or Coach? Please share your Enneagram Number, if you know it. Please upload a recent photo of you.Accepted file types: jpg, png, pdf, Max. file size: 128 MB.Please write a couple sentence introduction of how you would like to be introduced to the group—include where you live and your area of ministry.NotesPlease use the following link to 1) pay your $250 deposit to hold your spot at the retreat (not needed for currently enrolled CSD or CC students who are paying the monthly combined SSI/CSD or SSI/CC rate), 2) pay the balance of the cost of your retreat, and/or 3) pay an additional $250 for a single room at the retreat (on a space available basis). Please indicate the purpose of your payment on the payment form: Make a Payment Δ