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JPD/Critical Mass -  Spring '99 Retreat -  Registration Form

   Please mail to:
      LYNETTE  FULLERTON
      PO  BOX  333
      CROWNSVILLE, MD  21032


Name: _____________________________________ Home Phone: ______________

Address: __________________________________ Work Phone: ______________

City: _______________________ State: _____________ Zip: ______________

E-mail: ______________________________________________________________

Emergency Contact: _____________________________ Phone: ______________

Special Concerns (Allergies, etc.): __________________________________

Dietary Restrictions: ________________________________________________

Do you snore?  ________
(We usually have a snorer's room)


Do you need a ride?  ________

If you can give rides, to how many people?  ________


Do you wish to lead an informal workshop? ______

If so, Subject: ______________________________________________________


  Weekend cost (includes food) $55 (or $62 if postmarked after May 5)
    * Part-time cost (less that one day) is $40 if space is available
    * If you bring a child the extra cost is 1/2 the adult price


        Amount enclosed: $ _______


  - Retreat date: Friday evening to Sunday afternoon, May 14-16

  - Location: Camp Tockwogh in Maryland on the Chesapeake Bay
      To see pictures from past retreats see
      http://www.erols.com/ecarlson/uuyan/

  - Make check payable to GWA-UUYAN

  - RSVP by phone if it is too late for mailing

  - If you have questions contact:

      Lynette Fullerton  (301) 352-2375  l.fullerton@hotbot.com
      Ken Stroh . . . .  (410) 426-5235  (still no e-mail!!)
      Eric Carlson  . .  (703) 834-0356  ecarlson@erols.com

  - Please copy this form for your friends


I, ______________________________, understand that the trip
management reserves the right to remove anyone from the trip
at any time, for any reason they deem appropriate. I agree
to behave in a manner that is appropriate and cooperative
in the effort to create a caring, sharing community.


Signed, ____________________________________ Date _______________

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