Eliot Institute Camp Registration Form

Eliot Institute
Camp Registration Form

Registration for: (Please select only one. Each camp requires a separate registration form.)

July 2-9, 2005
Naramata, Canada
Rev. Stephen Jonasson
"Letters of the Spirit"

August 6-13, 2005
Seabeck, US
Will Hornyak
"Imagine!: Telling Stories, Changing Lives and Building Community"

July 16-23, 2005
Seabeck, US
Meg Riley
"Living Our Lives as Beacons: Connecting Faith, Values, and Action"

Winter 2005/2006
Seabeck, US
(Dec. 29-Jan. 2, Seabeck, US)
The Rev. Jeremy Taylor
"Reflections in the Pool of Wonder - Introducing Projective Group Dream Work"

About you: (Birthdays are requested for all, and required for anyone age 25 and under. The school grade is as of the date
of the conference. For summer camps, list grade for next school year.)
First/Last Bdate: Grade: M F   First Eliot?
First/Last Bdate: Grade: M F   First Eliot?
First/Last Bdate: Grade: M F   First Eliot?
First/Last Bdate: Grade: M F   First Eliot?
First/Last Bdate: Grade: M F   First Eliot?
Mailing Address:
City: State/Province: Zip/Postal Code:
Telephone Number: Primary Email:
E-mail 2: UU Congregation:

Housing Preference (if any): Room in:
Single room I/we will share a room only w/ those listed above I/we will share w/ others to be assigned
"Tier 1" room "Tier 2" room (least expensive) Room with private bath

Naramata only: Camping in RV Camping in tent

We will attempt to honor, but cannot guarantee, your requests. Need for accessibility is a priority.

Medical conditions/special needs which may require accommodation:
Need handicap accessibility Need ground floor Need room close to bathroom I snore
Sleep disorder - need quiet Other:
Dietary restrictions/preferences (please indicate who, if this application includes more than one person):

I am/We are sponsoring someone under age 18 who is not my/our own child. Forms are attached.
I/We request financial assistance. Forms are attached.
I wish to be considered for a Staff position:
I have no access to the Internet. Please send me all necessary forms and materials.
I am a UU minister. I am a UU minister-in-training.

How to Pay:
Include $50 U.S. Funds per person (check or money order) with registration for Seabeck camps. Include $50 Canadian Funds per person (check or money order) with registration for the Naramata camp. Make checks payable to Eliot Institute, and indicate session (Naramata, July, August or December) and the year on the check. Send payment with this registration to:

Eliot Institute
PMB 119
2600 NW Randall Way Suite 111
Silverdale WA 98393
US

Amount enclosed: Date submitted:

I have read the Registration Procedures on the website or provided to me and agree that I/my family will abide by all rules and policies of Eliot Institute and its host facilities. I will take responsibility for submitting sponsor and medical forms, if required. I enclose a $50 per person deposit in U.S. funds for each person listed on this form, for the July, August and December camps. I enclose a $50 per person deposit in Canadian currency for each person listed on this form for the camp at Naramata Centre, BC. I agree to pay the balance due when billed. I understand that registration is subject to late fees or cancellation if fees are not paid-in-full by the date due.

Signature of adult responsible______________________________________ Date signed:____________

Thank you for your registration
You may expect an advisory about your registration status within two weeks.

Please visit our website at www.eliotinstitute.org to review our fee schedules, Registration Procedures and policies, and our "Survival Guide" for more information on our programs and Conference Rules, and to obtain medical, sponsor and financial aid forms. Our web site also includes details on our host facilities and accommodations, driving directions and information on public transportation, staff and volunteer positions, and links to related organizations.

If you have additional questions about Eliot Institute, its programs or your registration, please contact:
Email: registrar@eliotinstitute.org
Voice Mail and FAX: 206-374-2497

- OFFICE USE ONLY -

Entered ___________
Deposit ___________ $_______
Confirmed ___________ email __ US Mail __
Invoiced ___________
Dean ltr ___________
Med ___________
Spons ___________
Pd in full ___________

	July 2-9, 2005 Naramata, Canada Rev. Stephen Jonasson "Letters of the Spirit"	August 6-13, 2005 Seabeck, US Will Hornyak "Imagine!: Telling Stories, Changing Lives and Building Community"
	July 16-23, 2005 Seabeck, US Meg Riley "Living Our Lives as Beacons: Connecting Faith, Values, and Action"	Winter 2005/2006 Seabeck, US (Dec. 29-Jan. 2, Seabeck, US) The Rev. Jeremy Taylor "Reflections in the Pool of Wonder - Introducing Projective Group Dream Work"