First Name   Middle   Last    

                         Name you prefer

Address   
     
City    State          Zip 

E-Mail       FAX 

Phone (home)       Phone (work)     Phone (Church)

Male     Female

Position held       Presbytery membership

 Medical dietary needs (be specific) 

Physical limitations (be specific)       

Spouse's name 
                    
                        Participating in spouse track   Yes    No    Will not be attending event

Have you completed Week I?   Yes   No       If yes, where and when?

Are you now serving as an interim?  Yes   No   or have you served in the last two years?  Yes   No

Commuter? Yes or No  

Roommate Preference
                

Fees may be paid by cash, personal chreck or money order.  We also now accept Discovery, Mastercard and Visa credit cards. 

 Send registration fee of $350 per interim participant or $425 for clergy and non-clergy participant

with registration by May 15 (Week 2) or June 10 (Week 1).    Balance due by June 20.

After June 10, $375 for clergy or $450 for clergy and non-clergy spouse.

Plus:         Room and Board per person      $315
       or
                Private Room and Board            $490
      or
                Commuter/fees (meals only)       $140

                                                                                             Make checks payable to:

Zephyr Point, P O Box 289, Zephyr Cove, NV   89448
Phone (775) 588-1835 or e-mail program@zephyrpoint.org
FAX (775) 588-1095.

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I would like to help another person enjoy a Zephyr Point sponsored event.  My Donation of $ is added to my amount due below.

                   Total enclosed $

(Registration fee and balance are non-refundable)

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In order for this registration to be complete,
the signature of the Executive Presbyter or Committee on Ministry Chair is required.
Print out form and give to Executire Presbyter to sign and FAX in.

Name __________________________________________
Title ___________________________________________

 

We recommend you print out the completed form for your records before you submit it.