Name

Address

City State Zip

Phone (XXX) XXX-XXXX

e-mail

Birthdate YYYY/MM/DD

Person to call in case of emergency:

Their phone number (XXX) XXX-XXXX

Medical concerns the conference staff should know:

Select all that apply:
I need a ride.
I have room for riders.
I would like to use air, bus, or train and be picked up (please contact us before making your travel plans, we may be able to arrange transportation from Washington DC, or others).

Meals:
I am strictly vegetarian.
I must eat meat.
I like veggies and meat.

I have other dietary concerns:

Accomodations:
Camping
Inside
I'll be visiting for the day or staying elsewhere

All participants must sign the following statement:

Attendees are asked to consider the range of ages and diversity of opinions and life-styles likely to be present at the conference in deciding what to bring and how to conduct themselves. Our aim is to make the conference inclusive and to assure that everyone has a positive experience. 

I agree to behave in such a manner that is appropriate and cooperative in the effort to create a caring, sharing community. I understand that the conference staff has the right to ask anyone to leave at any time for any reason. 

Signed: ________________________________________

I agree.

Persons under 18 must be accompanied by a parent or legal guardian.

HELP!!!!!!

I can help with the following activities:
Worship Service Coffee HouseHeavy Duty Food PrepRegistrationSmall Group Leader Opening or closing circle

I want to lead a workshop on:

Please tell us anything else about yourself and anything that would make this conference more enjoyable to you: