Asilomar 2010

"Enlighten Up!...Celebrate Your Sacred Joy"
Conference October 1-3, 2010
Sponsored by the West Central Region

First Name
Last Name

First Name
Last Name
(If a different address or separate room types, please complete a separate registration form)

Street Address 1
Street Address 2
City
State
Zip

Day Phone
Eve Phone
Cell Phone

Home Church

Vegetarian Meals
Name
Name

Disabled
Name
Please write a short description and list of needs

Requested Room Partner
(if registering separately)

Your Registration Fee Includes
Conference Fee, Housing Fee, Grounds Fee and Meals (Friday Dinner through Sunday Lunch)

	Dorm Room (3 - 4 people)	Double Room (2 people)	Single Room ( 1 Person)
Regular Price	$ 375.00 per person	$ 425.00 per person	$ 575.00

Rooms can no longer be assigned at the time of registration.
Off Grounds Registration Fees Includes
Conference Fee and Grounds Fee

Off Grounds Registration Fee, No Lodging or Meals = $230.00 Per Person
Off Grounds Registration Fee with Meals (Friday Night Dinner to Sunday Lunch) = $310.00

Non-Refundable Deposit Per Person = $175.00
Pay Full Amount Pay Deposit Only

Balance due by August 31, 2010
Your non-refundable, non-transferable deposit will guarantee your place for Asilomar 2010

Method of Payment
Cash Check Credit Card / PayPal

Email Address

Your Electronic Signature Date

You may also download this form and mail it in.