Form

We will gather Friday afternoon February 27, through Sunday afternoon March 1, 2009 with two overnights at Gwinwood Retreat Center in Lacey, WA. http://www.gwinwood.org/

We are very glad you are coming! If possible, please submit this registration BY JANUARY 26, 2009. That gives us time to plan (and pay) for meals, arrange drivers, etc. We ask that you be our Valentine & send in your registration BEFORE FEBRUARY 14. (Again, EARLIER is BETTER.)

This is the Credit Card or PayPal Account payment form for PLC Retreat registration (blue background). You do not have to have a PayPal Account to use this form, but if you do, you can choose a bank draft option that eliminates Ground Zero's (nominal) credit card transaction fee. If you intended to mail us your registration $$, please use the "white background" form instead at http://jotform.com/form/83532516608.

Please use your "Tab" key or mouse to move from question to question instead of typing the "Enter" key, which automatically SUBMITS your form before you've finished! Have fun. (Express Yourself)

First Name*

Last Name*

Best Phone contact*

Alternate Phone

E-mail*

Address*

Address Line 2

City*

State*

Country*

Postal Code*

If attending as a family, please list who is coming with you, including ages for attenders under 18. Additional contact information that is different from yours? (email, phone, address?)

Reminder: there will not be childcare or a children's program at the retreat.

Any dietary restrictions or special needs we should know about?

Your affiliation(s) -- any you care to list

Do you plan to risk arrest at the Sunday March 1st action?

Additional Comments? For example, do you already know you are seeking extra lodging for either Thursday Feb.26 and/or Sunday March1st overnights?

If you are a local resident, please indicate above whether you could help with driving and/or providing extra night(s) housing. Thank you!

Our Suggestions for Registration Payment per person. No one will be turned away for lack of funds. Please give more if you can; $100 is our best cost estimate to date.

$100 - Registration TOTAL $125 - INCREASED Registration (to help others) $75 - I need REDUCED Registration $50 - Honest Hardship Price $150 - Overflowing Abundance Price $25 - Paying a Little Now; Hope to Add More Later

Enter the U.S. Dollar amount you would like to pay via Credit Card or PayPal Account. (It is not a tax-deductible donation.)*

USD Donation

After you click the "Submit" button below, you will be taken to a PayPal screen to complete your payment transaction. THANK YOU for using our online form! The Northwest Region of Pacific Life Community WELCOMES you in advance to Retreat 2009. Stay in touch via the PLC Email Listserve; you can subscribe at http://lists.riseup.net/www/subrequest/plc And keep visiting & commenting at the PLC website: http://pacificlifecommunity.wordpress.com