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 (lower case): *
To develop future community, we may provide some participant information, but only to attendees, who are willing to share their own.
I agree to EXCHANGE my name, city & state with other conference attendees via a list of participants?	Yes
You may share my name & address on the general mailing list.	Yes
Registration: Choose room type: *	Commuter Rate ($210) Double Occupancy Room ($490) Group in a Cabin (Dormitory Style) ($265) Individual in a Cabin (Dorm- style) ($285)
Single Occupancy Room REQUEST (I will send the additional $90(+3%) payment within 48 hours of notification of availability)	Yes
I registered for The Language of the Soul Pre-conference and will receive a $20 discount	Yes
Students (half-time or more) contact us for special student discounts. Student identification is required.
Note: All individuals MUST REGISTER SEPARATELY regardless of housing arrangements.
Double Occupancy - Motel-style Housing
Your Roommate's Name:
OR....
Provide me with Roommate:	Yes
Group Registering for Cabin Accommodations (Dormitory-Style 4 per cabin room)
Cabinmates' names (list yours as the fourth)
In a Cabin, I understand that I need to bring my own pillow and blankets, and that 1 set of sheets and a towel will be provided	Yes
Individual Registering for Cabin Accommodations (Dormitory-Style 4 per cabin room)
In a Cabin, I understand that I need to bring my own pillow and blankets, and that 1 set of sheets and a towel will be provided	Yes
Volunteer Opportunities
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 (e.g. music, dance or dance leadership, entertainment, etc...)	Yes
Work with bookstore	Yes
Provide someone a ride to or from PTI airport (fuel cost can 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
Hospitality -- help with one of the parties or receptions (serving etc...)	Yes
Other
Transportation
I would like help to connect with (a) fellow registrant(s) to ride together.	Yes
(We MAY be able to help those registrants who choose this option to communicate in order for them to see what, if anything, can work. By checking this option, you give us permission to share enough of your contact information to help make this connection possible.)
Liability Release (required)
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 in connection 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. An email button is also available on the website. Be sure to put "registration receipt" in the header.