Oregon Fellowship of Reconciliation

2012 Seabeck Conference Registration

Thu, 05/17/2012 - 18:10 | ofor

REGISTER Here

Primary Registrant

Put your information here. Use the other Registrant fields for any additional registrations in your party.

First Name *

Last Name *

Street Address *

Street Address Line 2

City *

State/Province *

Postal Code *

Postal Code Suffix

+4 digits of Zip Code

Country

Gender

Home Phone *

Mobile or Other Phone

Email *

Vegetarian or Vegan?

Yes

Sunday Evening Menu

Salmon

Vegetarian

Other dietary concerns

Workshops

Choose up to four workshops from the list in the brochure. Use Ctrl-Click to select their numbers from the box above.

I would be willing to...

Access Needs

Add this registrant to the Conference Directory

Yes

Additional Registrants

Registrant 2

These fields are for an additional member of your party.

First Name

Last Name

Street Address

Street Address Line 2

City

State/Province

Postal Code

Postal Code Suffix

+4 digits of Zip Code

Country

Gender

Age

(if under 18)

Relationship to Main Registrant

Home Phone

Mobile or Other Phone

Vegetarian or Vegan?

Yes

Sunday Evening Menu

Salmon

Vegetarian

Other dietary concerns

Workshops

Choose up to four workshops from the list in the brochure. Use Ctrl-Click to select their numbers from the box above.

I would be willing to...

Access Needs

Add this registrant to the Conference Directory

Yes

Registrant 3

These fields are for an additional member of your party.

First Name

Last Name

Street Address

Street Address Line 2

City

State/Province

Postal Code

Postal Code Suffix

+4 digits of Zip Code

Country

Gender

Age

(if under 18)

Relationship to Main Registrant

Home Phone

Mobile or Other Phone

Vegetarian or Vegan?

Yes

Sunday Evening Menu

Salmon

Vegetarian

Other dietary concerns

Workshops

Choose up to four workshops from the list in the brochure. Use Ctrl-Click to select their numbers from the box above.

I would be willing to...

Access Needs

Add this registrant to the Conference Directory

Yes

Registrant 4

These fields are for an additional member of your party.

First Name

Last Name

Street Address

Street Address Line 2

City

State/Province

Postal Code

Postal Code Suffix

+4 digits of Zip Code

Country

Gender

Age

(if under 18)

Relationship to Main Registrant

Home Phone

Mobile or Other Phone

Vegetarian or Vegan?

Yes

Sunday Evening Menu

Salmon

Vegetarian

Other dietary concerns

Workshops

Choose up to four workshops from the list in the brochure. Use Ctrl-Click to select their numbers from the box above.

I would be willing to...

Access Needs

Add this registrant to the Conference Directory

Yes

Registrant 5

These fields are for an additional member of your party.

First Name

Last Name

Street Address

Street Address Line 2

City

State/Province

Postal Code

Postal Code Suffix

+4 digits of Zip Code

Country

Gender

Age

(if under 18)

Relationship to Main Registrant

Home Phone

Mobile or Other Phone

Vegetarian or Vegan?

Yes

Sunday Evening Menu

Salmon

Vegetarian

Other dietary concerns

Workshops

Choose up to four workshops from the list in the brochure. Use Ctrl-Click to select their numbers from the box above.

I would be willing to...

Access Needs

Add this registrant to the Conference Directory

Yes

Registrant 6

These fields are for an additional member of your party.

First Name

Last Name

Street Address

Street Address Line 2

City

State/Province

Postal Code

Postal Code Suffix

+4 digits of Zip Code

Country

Gender

Age

(if under 18)

Relationship to Main Registrant

Home Phone

Mobile or Other Phone

Vegetarian or Vegan?

Yes

Sunday Evening Menu

Salmon

Vegetarian

Other dietary concerns

Workshops

Choose up to four workshops from the list in the brochure. Use Ctrl-Click to select their numbers from the box above.

I would be willing to...

Access Needs

Add this registrant to the Conference Directory

Yes

Registrant 7

These fields are for an additional member of your party.

First Name

Last Name

Street Address

Street Address Line 2

City

State/Province

Postal Code

Postal Code Suffix

+4 digits of Zip Code

Country

Gender

Age

(if under 18)

Relationship to Main Registrant

Home Phone

Mobile or Other Phone

Vegetarian or Vegan?

Yes

Sunday Evening Menu

Salmon

Vegetarian

Other dietary concerns

Workshops

Choose up to four workshops from the list in the brochure. Use Ctrl-Click to select their numbers from the box above.

I would be willing to...

Access Needs

Add this registrant to the Conference Directory

Yes

Registrant 8

These fields are for an additional member of your party.

First Name

Last Name

Street Address

Street Address Line 2

City

State/Province

Postal Code

Postal Code Suffix

+4 digits of Zip Code

Country

Gender

Age

(if under 18)

Relationship to Main Registrant

Home Phone

Mobile or Other Phone

Vegetarian or Vegan?

Yes

Sunday Evening Menu

Salmon

Vegetarian

Other dietary concerns

Workshops

Choose up to four workshops from the list in the brochure. Use Ctrl-Click to select their numbers from the box above.

I would be willing to...

Access Needs

Add this registrant to the Conference Directory

Yes

Registrant 9

These fields are for an additional member of your party.

First Name

Last Name

Street Address

Street Address Line 2

City

State/Province

Postal Code

Postal Code Suffix

+4 digits of Zip Code

Country

Gender

Age

(if under 18)

Relationship to Main Registrant

Home Phone

Mobile or Other Phone

Vegetarian or Vegan?

Yes

Sunday Evening Menu

Salmon

Vegetarian

Other dietary concerns

Workshops

Choose up to four workshops from the list in the brochure. Use Ctrl-Click to select their numbers from the box above.

I would be willing to...

Access Needs

Add this registrant to the Conference Directory

Yes

Financial Assistance & Scholarships

Enter the amount you are taking in financial assistance (up to $100 per adult) and/or the amount of your scholarship request in the boxes below.

Washington/BC

Low-Income Discount $

I/We are Washington or British Columbia residents and have taken a low-income discount.I/We understand this is subject to availability on a first-come basis, sliding scale.

Scholarship Request $

I/We are Washington or British Columbia residents and request a scholarship in the amount entered above..

Oregon & Elsewhere

Low-Income Discount $

I/We are residents of Oregon (and anywhere else) and have taken a low-income discount. I/We understand this is subject to availability on a first-come basis, sliding scale.

Scholarship Request $

I/We are residents of Oregon (and anywhere else) and request a scholarship in the amount listed below.

Support for Request

Please provide the financial assistance committee any information you are willing to share to help them make a decision. You may write your statement using a text editor, and then copy and paste the text into the field below.

Carpooling

Ride(s) offered people

Enter the number of spaces above.

Ride(s) needed. people

Enter the number of persons needing rides.

Carpooling - Special Information

Use this text area to help make your carpooling experience as smooth as possible. For instance: Are you leaving from a location not your home, or do you need a ride in only one direction?

...creating a culture of peace for the people of Oregon

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2012 Seabeck Conference Registration