Form

General Information and Payment Information
First Name: *
Last Name: *
Name for the Badge:
Daytime Phone:
Evening Phone:
Street Address:
City:
State:
Postal/Zip Code:
Country:
E-mail: *
For developing future community, we may provide some participant information, but only to attendees, who aer willing to share their own.
May we share your name, city, state and email on a list to go to the conference attendees?	Yes
May we share your name and address on our general mailing list?	Yes
Registration: Choose room type. Upon form submission will be taken to a form to enter your credit card information via secure server.	Double Occupany Room ($490) Commuter Rate ($230) Group in Cabin (Dormitory Style) ($260) Individual in Cabin (Dormitory Style) ($275) Total : $0
Single Occupancy Room Request (additional $90 payment to be sent within 48 hours of notification of availability	Yes
Students (half-time or more) contact us for special student discounts with student identification.
Note: All individuals MUST REGISTER SEPARATELY regardless of housing arrangements.
Double Occupancy - Motel Style Housing
Your Roommates Name:
OR....
Provide me with Roommate:	Yes
Group Registering for Cabin Accommodations (Dormitory Style 4 per cabin room)
Roomates Names (list yours as the fourth)
I understand that I need to bring my own pillow and blankets, and that 1 set of sheet and towels will be provided	Yes
Individual Registering for Cabin Accommodations (Dormitory Style 4 per cabin room)
I understand that I need to bring my own pillow and blankets, and that 1 set of sheet and towels will be provided	Yes
Volunteer Opportunitites
Please contact me to discuss how I can use my talents to help	yes
I am qualified to facilitate a dialogue group	Yes
I have a special talent (eg music, dance or dance leadership, entertainment, etc	Yes
Work with bookstore	Yes
Provide someone a ride to or from the airport (fuel expense to be reimbursed)	Yes
Provide hands-on help with set-up and clean-up etc....	Yes
___ I will bring my digital camera to take pictures for our conference closing ceremony slide-show	Yes
I would be willing to pick up someone at the Greensboro airport with the understanding that they would reimburse me for the extra gas expense.	Yes
Other
Transportation
I may want to share a ride and fuel expenses with a fellow registrant driving from or through my area.	Yes
(We may be able to help those registrants who choose this option to communicate in order for them to see what, if anything, cannwork. By checking this option, you give us permission to share enough of your contact information to help make thisnconnection possible.)
Liability Release
In order to satisfy legal requirements, you may be asked to sign liability release at on-site registration)
I agree to indemnify and hold harmless The Board of the Seeds for Jubilee Foundation and its members and anyone involved in planning and/or hosting Journey Conferences from any loss or damage to personal property or any personal damage or injury resulting from, caused by or occurring during or innconnection with, my participation in a Journey Conference or program.
I agree	Yes
If you do not receive an e-mail confirmation within 30 days. Please contact our central office at info@journeyconferences.com (email link also available on the website).