Registration
REGISTRATION FORM
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Christian Peacemaker
CONGRESS X
Restoring Balance: Building Peace through Right Relationships
September 17-20, 2009
Denver, Colorado
Name(s):_________________________________________________________
Street Address or PO Box:______________________________________________________
City: _______________________________________Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Phone:______________
State/Province/Country:_______________________Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Zip/PostalCode:__________
E-Mail:____________________________________
PAYMENT
| Â | Â $ US |
 $ CAN |
| ____ Adults
@ US$100/CAN$110 per person or US$4/CAN$5 per $1,000 of your income,whichever is higher: (US$110/CAN$120 after Aug. 1)Â Â Â |
 $_____ |  $_____ |
| Â ____ Students/Low Income @ US$30/CAN$35 person: (US$35/CAN$40 person after Aug.1) | Â $_____ | Â $_____ |
| Â ____ Daily Rate @ US$30/CAN$35 per person/day | Â $_____ | $_____ |
| Â ____ Children under 12 @ $10/child | Â $_____ | $_____ |
| Â | Â | Â |
| Â ____ I am unable to attend the Congress.... | Â | Â |
| Â Â Â Â Â Â ____ ...enclosed is my gift of | Â $_____ | Â $_____ |
| Â Â Â Â Â Â ____ ...I will pray for the Congress | Â | Â |
| Â | Â | Â |
| Â TOTAL ENCLOSED |
 $_____ |  $____ |
LODGING
I would like to stay:
____with a local host family (suggested donation: $5 per night). Â Â Home hospitality will be arranged for those who indicate this preference. Â Â Indicate the number of spaces required: ______
____on the floor (bring your own sleeping bag and mat).
TRANSPORTATION
(Note: the Congress will try to help with transportation coordination but will not make guarantees.)
____ I will be driving to Denver from ____________________________ and will have room  for ____ extra passengers.
____ I would like to carpool with someone else who is driving.
____ I am
traveling by bus/train and need transportation to the Congress site.Â
Scheduled arrival:
Date___________ Time_______
____ I will need transportation from the airport.
Airline________________ Flight #________
Date______________ Time__________
OTHER NEEDS
____ I will need help with childcare for ____ children, ages ________________.
____ I am willing to help with childcare.
____ I will need facilities to accommodate a physical disability as follows_____________________________________________________________.
____ I/we
need meals to accommodate the following dietary needs; list dietary need and number
of persons with this need:
______________________________________________________________________
_______________________________________________________________________
Other
Comments:________________________________________________________
___________________________________________________________________________________________
Return completed registration form with
a check in either $US or $CAN payable to:
CHRISTIAN PEACEMAKER TEAMS
Send to: PO Box 6508, Chicago IL 60680
| Attachment | Size |
|---|---|
| Congress X Registration Form.pdf | 47.22 KB |