Registration Form
Please plan to register early; space is limited. Sometimes we have had to turn away families because of the space limitation. Rooms accommodate two people (two single beds and private bath), and one or two additional family members may be accommodated in the same room on the floor if you wish to bring bedding for them. Single adults who wish to room together should send in their registration forms together, otherwise they will be paired with other singles. (Note: There is an additional $30 charge for a single person who requests a private room.) 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: Carolynn Boyd, Registrar 1162 Lucy Drive Schwenksville, Pa 19473 Registration deadline is January 20, 2017* [*Availability of meals & lodging not guaranteed after Jan. 20th - check with Registrar] Any questions? Need more information? See http://efpjc.ppjr.org/retreat/efp172.htm, or Call Carolynn Boyd, 610-489-9084, E-mail: fcboyd@verizon.net |