Program Registration Form

Please use this form to send your registration information. One is not officially registered for a workshop until the $50 nonrefundable deposit is received. Please mail check or call the office with your credit card information.

Personal Information

Name: *

Address:

Address 2:

City:

State:

Zip Code:

Phone Number (Home):

Phone Number (Work):

E-mail address:

Program Information

Arrive:

Depart:

Arrive by dinner Friday (6:30pm):

Yes

If no, what time will you arrive?

Arrive:

Depart:

Arrive by dinner Friday (6:30pm):

Yes

If no, what time will you arrive?

Participants

Number of Adults

Male:

Female:

Number of Children under 12

Male:

Female:

Housing Preference:

Cabin/House

Dormitory

Camping

Commuter

Transportation

How will you be traveling:

Driving

Train

Would Like a Ride?

If you can take passengers, how many?:

Additional travel info:

Financial Information

One is not officially registered for a workshop until deposit is received: *

I will mail a check

I will call Pumpkin Hollow during office hours with my credit card information (518-325-3583).

Additional comments:

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Program Registration Form