Alumni Reunion 2017 Registration 18th Annual Cirque Lodge Alumni Reunion September 22nd, 23rd and 24th 2017 Alumni InformationAlumni Name:* First Last Phone*Email* Address* Street Address City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe We’d like to give you some gifts! Please select your shirt size.Extra SmallSmallMediumLargeExtra LargeGuest InformationThe reunion is free of charge to all Cirque Lodge Alumni. Spouses, significant others and friends in recovery are welcome to join us! The cost for additional guests is $100.00 per person. This includes all activities and events including all meals, and a Cirque Lodge Candle. All donations from guest registration go to the Cirque Lodge Foundation. . Are you bringing a guest to this year's reunion?*YesNoIf so, please select your guest’s shirt size.Extra SmallSmallMediumLargeExtra LargeNumber of Guests:Select12345678910Name of Guest(s): Cirque Lodge FoundationIf you have the ability, we would ask you to consider making a donation to the Cirque Lodge Foundation. Donations to the Foundation are tax deductible and go for the strict purpose of patient aid. We receive weekly, dozens of phone calls from people who, although deserving of treatment, have little or no means of accessing care. Although we have made treatment available to many, our resources are limited. We pray for the day that funds will not keep someone from getting the chance to experience the power of the mountain. Your gifts are appreciated.Would you like to make a donation to the Cirque Lodge Foundation?YesNoDonation Amount: Credit Card InformationTotal $0.00 Card Holder Name:Credit Card #Card TypeVisaMaster CardAmexDiscoverExp. Date:Sec. CodePhoneThis field is for validation purposes and should be left unchanged.