Registration Form

Title:	Select Mr. Mrs. Miss Dr. Rev.
First Name:
Middle Init:
Last Name:
Address:
City:
State:	Select ** -- **Blank** AK -- Alaska AL -- Alabama AR -- Arkansas AZ -- Arizona CA -- California CO -- Colorado CT -- Connecticut DC -- District of Columbia DE -- Delaware FL -- Florida GA -- Georgia GU -- Guam HI -- Hawaii IA -- Iowa ID -- Idaho IL -- Illinois IN -- Indiana KS -- Kansas KY -- Kentucky LA -- Louisiana MA -- Massachusetts MD -- Maryland ME -- Maine MI -- Michigan MN -- Minnesota MO -- Missouri MS -- Mississippi MT -- Montana NC -- North Carolina ND -- North Dakota NE -- Nebraska NH -- New Hampshire NJ -- New Jersey NM -- New Mexico NV -- Nevada NY -- New York OH -- Ohio OK -- Oklahoma OR -- Oregon PA -- Pennsylvania PR -- Puerto Rico RI -- Rhode Island SC -- South Carolina SD -- South Dakota TN -- Tennessee TX -- Texas UT -- Utah VA -- Virginia VI -- Virgin Islands VT -- Vermont WA -- Washington WI -- Wisconsin WV -- West Virginia WY -- Wyoming
Zip
Day Phone:	format (999)999-9999 (only enter the numbers)
Night Phone:	format (999)999-9999 (only enter the numbers)
Cell Phone:	format (999)999-9999 (only enter the numbers)
Gender:	Select Male Female
Email:
Blog:
Website:
Registration:	Select Adult (first timer) - no discount Teen (18 and under) - 60% off Alumni (any year) - 10% discount Full-time student - 10% discount Pastor - 10% discount Senior (65+) - 10% discount Spouse attending - 25% discount Coming for Wednesday Only - no cost
YMCA Member:	Select Yes No
Housing:	Select Staying in Alpen (meals included from dinner day of arrival through day of departure) Staying in Longs Peak (meals included from dinner day of arrival through day of departure) Renting a cabin (meals not included but can be purchased on next page) Commuting (meals not included but can be purchased on next page) Staying somewhere else (meals not included but can be purchased on next page) Not Yet Certain (please email haleybarb@yahoo.com as soon as your plans are firm)
	Please note that if you are not a YMCA member and are not staying in Alpen, Longs Peak, or a YMCA cabin you will be charged the YMCA's daily use fee of $18.
Verification Check:	Type the characters that you see in this picture. Characters are not case-sensitive.

After you hit submit, you will be taken to another page where you can select your continuing session and workshops
(or the clinic you plan to apply for that meets during the six workshops).
If you are not yet certain of your choices, you can email them after you register.
Please complete your registration within 30 minutes
or you will have to reenter your information.