Step 1) (print clearly)
Name _________________________________________________
Address _________________________________________________

City ______________________St _________ Zip _____________

Phone ______________________ (h) _____________________ (o)

Email _____________________________________

Church Name/Location ____________________________________

Clerk’s Signature ________________________________________

Step 2) Status (choose 1)
____ Clergy w/standing in ME
____ Lay delegate
____ Youth delegate*
____ Coordinating Council
____ Commission/Committee
____ Association Officer
____ Visitor
____ Exhibitor

*send youth health form w/reg
materials

Step 3 ) Workshops workshops04.htm
Session 1
First choice ___ Second Choice___

Session 2
First choice ___ Second Choice___

Step 4) Specific Needs
Dietary, Vision, Hearing, Housing,
Transportation. Please be specific.
Call Conference office
Ask for Cheryl - 1-800-244-0937

Step 5) Child/Youth Care
Fill out Child/Youth Care Form Childcare and mail directly to Sunday River, Bethel, Maine. Deadline: August 23, 2004

Hotel and Condo Reservations Call Grand Summit
Sunday River, Bethel (mail or fax this form only)  -  Deadline: Aug 23, 2004 - Tell them you are with the UCC

__ I/we understand that if we stay at the Grand Summit Hotel in Bethel we are responsible for our hotel/other incidental expenses as well as any damage resulting in our stay.
______ initials

Step 7) Pre-Annual Meeting Retreat Retreat

September 23-24, 2004 from 1:00 p.m. to 1:00 p.m.
Learning to Look Through Different Lenses: Understanding Diverse Faith Perspectives
Retreat Cost: $50.00 per person (includes program and 3 meals)
Accommodations are made directly with hotel (mail or fax this form only)

____ I will be attending this retreat

Step 8) Registration Fee
Adults: $35 ($40 after 8/23)
Youth: $15 ($20 after 8/23)
(Youth are18 and under)

Step 9) Meals: *Meals
Friday Dinner H C V (circle one)         $ 23.54 _______
Sat Box Lunch R H T V (circle one)    $ 12.39 _______
Sat Dinner Sir Sal T V (circle one)      $ 25.96 _______
Sun Lunch Buffet                                  $ 20.06 _______
Special Invitational Meal
Sat. Retired Clergy/Spouse Luncheon $ 7.00 _______
                                                           Total Meals $_________
*If no meal selections are circled a chicken or turkey dish will be selected for you.

Special Group Meals: (please check if you plan on attending)
__ Clergy Spouse Breakfast: Saturday in the Riley/Ketchem Room
__ Bangor Theological Seminary: Bring the box lunch to Riley/Ketchem Rm
__ Association Officers Gathering: Sat Night in Riley/Ketchem Room

Grand Totals of 7, 8, 9
7. Registration Fee $ ________
8. Retreat ________
9. Meals ________
Grand Total enclosed $__________
*If no meal selections are circled a chicken or turkey dish will be selected for you.