First Name   Middle   Last    

                            Name you prefer

Address    E-Mail   FAX
     
City    State          Zip 

                      Phone (home)       Phone (work)

Male     Female

Position held       Presbytery membership

 Medical dietary needs (be specific) 

Physical limitations (be specific)       

Spouse's name 
                     Participating in spouse track   Yes    No    Will not be attending event

Have you completed Week I?   Yes   No       If yes, where and when?

Are you now serving as an interim?  Yes   No   or have you served in the last two years?  Yes   No

Commuter? Yes or No  

Roommate Preference
                                           We will accommodate if possible with early registration

We must receive a deposit check within 10 days of this registration to secure your space.
Fees may be paid by cash, personal chreck or money order.  (Sorry, no credit cards.)
  Send registration fee of $350 per interim participant or $425 for clergy and non-clergy participant
with registration to June 10.  Balance due by June 20.

                                        Total for event  $      Deposit (within 10 days) $

(Registration fee and balance are non-refundable)

In order for this registration to be complete,
the signature of the Executive Presbyter or Committee on Ministry Chair is required.
Print out form and give to Executire Presbyter to sign and FAX in.

Name __________________________________________
Title ___________________________________________

  Make checks payable to:
Zephyr Point Presbyterian Conference Center
P O Box 289, Zephyr Cove, NV   89448

For additional information
Phone (775) 588-1835 or e-mail lynne@zephyrpoint.org
FAX (775) 588-1095

We recommend you print out the completed form for your records before you submit it.