Registrant Name 1  

                Name 2

Address    E-Mail 
     
City    State          Zip 

Phone (home)       Phone (work)

Church     Location 

Children(s) full name (if attending)   Age at 7/10   Gr

                                                      Age at 7/10   Gr

                                                      Age at 7/10   Gr

                                                      Age at 7/10   Gr

Dietary Needs:

Diabetic     Lactose Intolerant   Gluten Free   Vegetarian    Low Fat   Other

       Names of those with special dietary needs

                         Food is served in the dining hall; staff has limited ability to prepare special diets.

There are NO PRIVATE ROOMS.  You will be assigned a roommate unless you sign up as a double.
To request a roommate, both registrants must sign up together.
Roommate Name

Zephyr Experience T-Shirts $12 Each  -  New This Year!    Buy 3 or more for $10 Each    
       X-Small                                                 
       Small        
       Medium    
       Large        
      X-Large     
      Number of Shirts You Are Ordering 
      Total for T-Shirt Order                $   
               Please add your Shirt Order in your Deposit Check.              

Lodging - Tahoe Center                                             Fee                       After 6/1
     No. of  Adults                         x  $485                        $500
     No. of Youth, 10-17              x  $210                         $220
     No. of Children 3-9                x  $150                        $160
          (2 and under free)                                            
                                                              Total Fees $

       We need a handicap accessible room 

If Tahoe Center room not available, will stay in a cabin     YES       NO        Wait list for Tahoe

Cabins                                                        Fee                                   After 6/1
     No. Adults                              x  $310            $325
     No. Youth (10-17)                 x  $170              $180
     No. Children (3 - 9)                x $130                       $140      
   
                                                               Total Fees $

If cabin not available, will stay in Tallac Center      YES      NO     Wait list for Cabin

Commuter                                                        Fee                                    After 6/1
      No. of Adults                                x $230               $240
      No. of Youth  (10 -17)                 x $150               $160
      No. of Children (3 - 9)                  x $115               $125
         (2 and under free)        
                                                                                Total Fees $

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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 for event (including T-shirts and donation)  $  

                                                   (Registration fee and balance are non-refundable.)

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Card Holder Information Required for Online Payment by Credit Card      

(note registration is done on a secure server)

Name on Credit Card

Phone (home)  

Street Address 

City      State        ZIP

Card Number         Expires  Year    Month 

Authorized Amount ($)

If not paying online with credit card, we must receive a deposit check within 10 days of this registration to secure your space.           

Send full payment if possible, or send non-refundable deposit.
Events offering discounts must be postmarked by deadline dates.
Total balance (non-refundable) is due in advance as stated per event.
Include event name on check.

Send deposit to:
Zephyr Point Presbyterian Conference Center
P O Box 289, Zephyr Cove, NV   89448

All Registrations accepted on a first-come, first-serve basis by postmark (or receipt of e-mail registration form)
The remainder of your fee is due by June 1, 2010.
Cancellation Policy: all fees are non-refundable after June 1, 2010*

A limited number of partial scholarships are available.    Please inquire if you have need.
Donations to the Scholarship Fund are invited.

*Travel/Trip Cancellation Insurance is available for cancellations that take place after the final due date.  Since we cannot refund after June 1, 2010, with insurance you can still be covered if last minute illness or mishaps arise.  It needs to be purchased within 14 dates of deposit.  For details call Travel Guard 1-800-826-4919 or for web info: www.travelguard.com

Don't forget to fill out Adult and Children/Youth Course selections below.

"Submit Button" is at bottom of form, after course selections.

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SELECTIONS - ADULT COURSES

First Person Name                              
First Period Class          First Choice      
                                     Second Choice 
Second Period Class      First Choice     
                                     Second Choice 

Second Person Name                           
First Period Class          First Choice       
                                     Second Choice  
Second Period Class      First Choice      
                                     Second Choice  

Please note that all courses are on a first-come, first-serve basis.

CHILDREN/YOUTH PROGRAMS AGES 4 - 17 years

Name       Grade (Fall '10)      Age (as of 7/10)

Name       Grade (Fall '10)     Age (as of 7/10)

Name       Grade (Fall '10)     Age (as of 7/10)

Name       Grade (Fall '10)      Age (as of 7/10)

Special Needs:
    Are there any special limitations or situations your child's teacher needs to know about in order to best support you and your family?

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

Remember we must receive a deposit check within 10 days of this registration to secure your space.