Return

PSD Annual Conference Registration Form (2001)

Register by March 23, 2001, and take the early registration discount. Use a separate form for each adult registrant and each youth registrant (ages 13-18). For each youth registrant, please include the name of an adult sponsor (a parent or other adult who will be attending the conference). Children, 12 and under, should be registered on an adult's form.   PLEASE PRINT

Registrant
[] Adult     [] Youth : Sponsor __________________________________________
Name (for name tag) _______________________________________________
Address _______________________________________________
City, State, Zip _______________________________________________
Phone (_____)________________________________________
Email _______________________________________________
Your congregation _______________________________________________

Workshop Registration
A: 10:20-11:45 a.m.     B: 1:30-2:45 p.m.     C: 3:00-4:15 p.m.    
1st choice : A ___ 1st choice : B ___ 1st choice : C ___
2nd choice : A ___ 2nd choice : B ___ 2nd choice : C ___

Special Needs
[] I need Home Hospitality lodging.
[] Put me on the "want roommate list" and send me a copy.
[] I have special meal requests (specify):
[] I need other special assistance to participate in the conference (describe):
      ____________________________________________________________________________________

Table Topics:   At breakfast on Saturday and Sunday, you'll have opportunities to sit and talk with others interested in discussing a common topic. If you have an idea for a Table Topic, please note it here and provide the name of a person attending the conference who is willing to lead the discussion:
      ____________________________________________________________________________________

Child Registration:   Your registration must be postmarked no later than March 23, 2001, to be eligible for child care. Child care with age-appropriate activities for children 12 and under will be provided for a fee of $32 per child. Care will be available Friday 6:45 - 10:00 p.m.; Saturday 9:00 a.m. - 10:00 p.m.; Sunday 9:00 - 10:30 a.m. Fee includes Friday evening snack, lunch/dinner/snacks on Saturday and snacks on Sunday.
Child’s name: ___________________________________________     Age: _______
Child’s name: ___________________________________________     Age: _______