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CCI USA 2008 REGISTRATION FORM April 22 – 27, 2007 SEND REGISTRATION FORM AND DEPOSIT PAYABLE TO CCI-USA ($US only) TO: Bonnie Cameron PO Box 525 Vernon CT USA 06066 (Tel: 860.871.6519, E-M: [email protected]) Name : Address : Telephone : E-mail address : *** I ___ DO ___ DO NOT want my contact information shared with the community I plan to bring my children who are ages : Fundamentals Teacher & Year : ___ This is my first CCI-USA workshop I am a ____ Male ____ Female I do NOT eat ____ Fish ____ Dairy ____ Red Meat ____ Poultry ____ Other (Please provide additional information on the back of this form) I AM ____ Vegan (no egg, no dairy) HOUSING & TRANSPORTATION ____ I need a ride to the workshop ____ I need a place to stay ** BEFORE the workshop ** Individuals are responsible for arranging their own lodging and travel for AFTER CCI. Space will be provided during the workshop to make arrangements. Please use this space to provide information about housing or transportation needs : Please indicate here any mobility problems : ____ I can provide housing for ____ people ____ I can provide a ride for ____ people Housing at the Workshop ____ No roommate preference; please assign me a roommate ____ with other men ____ with other women ____ no gender preference ____ I would like to room with _________________________________ (Please consult to make sure your forms agree) ____ I don’t know who I’d like to room with, but I’ll let you know by March 15th ____ I need a family room for ____ adults and ____ children ____ I am a noisy sleeper ____ I am a light sleeper There will be only limited options to negotiate any room switches REGISTRATION ___ $ 675 *Single Occupancy ___ $ 535 *Double Occupancy ___ $ 485 *Multiple Occupancy ___ No Charge [ Child under 4 years ] ___ ½ Adult rate [ Child 5 – 12 years ] ___ Adult Rate [ Child 13 and older ] * EARLY BIRD REGISTRATION > subtract $ 25 if deposit received by 02.15.08 Do you have a scheduling conflict? Contact Michelle Gornish at 860.989.3907 for registration options. I need $ ________ from the Bursary Fund in order to attend CCI-USA 2008 (Request must be received by 02.15.08) Please indicate: Enclosed is my check for $ ________ Deposit (50% of total workshop fee requested) > If less than 50%, Payment Plan is required $ ________ Donation towards Bursary Fund $ ________ Donation towards general workshop fund $ ________ { $ 50 non-refundable processing fee for cancellations after April 11, 2008 } Please outline your payment plan here (use reverse side, if needed):