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JPD/Critical Mass - Spring 2000 Retreat - Registration Form

   Please mail to:
      JEANNE SWAN
      10526 HUNTERS VALLEY RD.
      VIENNA, VA 22181


Name: _____________________________________ Home Phone: ______________

Address: __________________________________ Work Phone: ______________

City: _______________________ State: _____________ Zip: ______________

E-mail: ______________________________________________________________

Emergency Contact: _____________________________ Phone: ______________

Special Concerns (Allergies, etc.): __________________________________

Dietary Restrictions: ________________________________________________


Do you need a ride?  ________

If you can give rides, to how many people?  ________


Do you wish to lead an informal workshop? ______

If so, Subject: ______________________________________________________


  Weekend cost (includes food) $60 (or $68 if postmarked after May 6)
    * Part-time cost (less than 24 hours) is $40 ($48 after
          May 6, please contact the registrar before registering).
    * If you bring a child the additional cost is half of the adult cost.
    * Refunds requests are reviewed on a case-by-case basis.
	  Preference is given to those who notify the registrar earliest.

        Amount enclosed: $ _______


  - Retreat date: Friday evening to Sunday afternoon, May 19-21, 2000

  - Location: Camp Mardela in Denton, Maryland
      To see pictures from past retreats see http://www.critmass.org

  - Make check payable to GWA-UUYAN

  - RSVP by phone if it is too late for mailing

  - If you have questions contact:

      Jeanne Swan . . .  (703) 938-4954  swanjeanne@aol.com
      Ken Stroh . . . .  (410) 426-5235  kenstroh@aol.com
      Eric Carlson  . .  (703) 834-0356  ecarlson@erols.com

  - Please copy this form for your friends


I, ______________________________, understand that the trip
management reserves the right to remove anyone from the trip
at any time, for any reason they deem appropriate. I agree
to behave in a manner that is appropriate and cooperative
in the effort to create a caring, sharing community.


Signed, ____________________________________ Date _______________

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