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: _______________________________________                            Phone:______________

State/Province/Country:_______________________                              Zip/PostalCode:__________

E-Mail:____________________________________

 

PAYMENT

	$ 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)	$_____	$_____
____ Students/Low Income @ US$30/CAN$35 person: (US$35/CAN$40 person after Aug.1)	$_____	$_____
____ Daily Rate @ US$30/CAN$35 per person/day	$_____	$_____
____ Children under 12 @ $10/child	$_____	$_____
____ I am unable to attend the Congress....
____ ...enclosed is my gift of	$_____	$_____
____ ...I will pray for the Congress
TOTAL ENCLOSED	$_____	$____

 

LODGING

I would like to stay:

____with a local host family (suggested donation: $5 per night).   Home hospitality will be arranged for those who indicate this preference.   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. 
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