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Registration Form
Most rooms accommodate up to four people (a double bed and a bunk bed with private bath), and one or two additional family members may be accommodated in the same room on the floor if you wish to bring sleeping bags for them. Single adults who wish to room together should send in their registration forms together; otherwise they will be paired with other singles if space is limited. Special needs: If you have dietary restrictions or require other special accommodations (e.g., diabetic, or vegetarian, or difficulty climbing stairs, etc.) please include information about your needs.
Name__________________________________________________________________ Address_______________________________________________________________ City, State____________________________________________ZIP____________ Phone______________________________E-mail_____________________________ [check here ___ if you do not want to be included on the Peace & Justice Committee's email list.] Children/Youth: NAME AGE GENDER _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________
Make checks payable to: Eastern District Conference
Mail this registration form to:
Becky Felton
942 Camp Trail Road
Quakertown, PA 18951
Registration deadline is January 22, 2010*
[*Availability of meals & lodging not guaranteed after Jan. 22nd - check with Registrar]
Any questions? Need more information?
See http://efpjc.ppjr.org/efp102.htm, or
Call Becky Felton, 215-536-7935, E-mail: bbfelton@verizon.net
or Robert Walden, 610-861-0653, E-mail: RWaldenPA@entermail.net
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