Native Plants and Permaculture Registration Form

May 11-13 (Friday late afternoon through Sunday), 2007 at Lost Valley Educational Center, Dexter, OR

For easiest online registration, please fill out the form here.

You may also copy and paste the text below into an email, complete and send to nature AT(replace with @) lostvalley.org, or print and send the completed form to Native Plants and Permaculture Registration, 81868 Lost Valley Lane, Dexter, OR 97431 USA.

Name:_______________________________________________________________
Address:_____________________________________________________________
_____________________________________________________________________ 
Phone(s):_____________________________________________________________
Email:________________________________________________________________

Conference Fees:
__$90 for full conference, Friday, May 11 through Sunday, May 13
--or, if registering for partial conference--
__$50 single full day: __Saturday, May 12 __Sunday, May 13
__$20 Friday, May 11 afternoon and evening only

Lodging: $30/night dormitory accommodations __Friday __Saturday __Sunday
--or--
$10/night camping spot __Friday __Saturday __Sunday
Total lodging/camping cost: $____

Organic Vegetarian Meals:
__$70/full weekend: Friday dinner through Sunday dinner, including breakfasts, lunches, and dinners
--or--
$30/day (includes breakfast, lunch, dinner): __Saturday __Sunday
breakfast: $8/meal: __Saturday __Sunday
lunch: $10/meal: __Saturday __Sunday
dinner: $15/meal: __Friday __Saturday __Sunday
Total meal cost: $____

Laura Kemp Concert (Sat., May 12, 8 pm, reserved, preferred seating; other attendance will be by donation):
__$10 (all proceeds to artist)

Nature Center Membership Contribution (receive e-newsletters and other member benefits, and help support the Nature Center):
__$25
__$50
__$100
__other: $____

Scholarship Donation (help others with limited funds attend this gathering):
__$25
__$50
__$100
__other: $____

Total of Conference Fees, Lodging & Meal Costs, Concert, Nature Center and Scholarship Donations: $____
Payment method: __check
__credit/debit card: Type:___________
Number:________________________
Expiration date:__________________
Name on card:____________________________

Additional Questions:
How did you hear about this event?__________________________________________ 
Carpooling Is Encouraged:
Can you offer a ride? (if yes: when, and from where?)_____________________________
Would you like a ride? (if yes: when, and from where?)____________________________
Do you have any additional suggestions or questions?_____________________________________________________________

If online, email, or postal mail registration is not possible or convenient for you, you may also call 541-937-2567 ext. 116. Payments may be made via check (payable to Lost Valley Center) or credit/debit card (by mail, over the phone, or online; when paying online, please enter total payment under "other" in "Donation Amount" category, then select "Native Plants and Permaculture" under "Course Payments" pulldown menu).