Name:       

Address:  

City:    State:    Zip:

Home Phone:    Work Phone:   Cell Phone:

Email:  

Age:       Please Indicate Age Range 10-15 - $160 16-21 - $185 Over 21 - $260

adult registering with my mother or adult daughter:
 $25 discount   Name of qualifying adult:  

group I wish to  bunk with (if any) 

housing preference:    Please Indicate Housing Preference A-Frame with bunk bed Cabin Dorm with bunk bed Cabin Tent with bunk bed Camping bringing my own tent RV - Limited Spaces - Get Approval First

bunk beds:

 I am able and willing to climb up to an upper bunk.
 I do not wish to occupy an upper bunk.

payment:

Please indicate payment option $40 deposit Online by PayPal Payment in full online by PayPal I'm sending $40 deposit check or money order I'm sending payment in full by check or money order

  I plan to  vend at the barter faire.   I don’t plan to vend at the barter faire.

Send me extra fliers to pass out to friends.

I heard about Retreat:   Please indicate one Past Attendee From a friend or relative Saw a flier or post card Saw ad in Vision Magazine Saw ad in The Light Connection Other

Additional Comments:

Unless you have an onboard E-mail program such as Outlook Express that is on your computer, you may be unable to submit this form via your E-mail. For best legibility, fill out the form here, print and send to: Universal Life Church  PO Box 70131 San Diego, CA 92167 or fax to 619 226 0636. If sending a check or money order, please make payable to Universal Life Church or ULC. Donations to this nonprofit organization may be tax deductible.