Name:
Address:
City: State/Province Postal Code:
Country (if other than USA)

Home Phone: - Work Phone: -
Email address, if available

Name of Meeting Yearly Meeting

Payment is due before General Board sessions. I will pay by:
Check
Credit Card

I plan to attend the following:
General Board
General Board Executive Committee
Finance Committee
PCPC
Triennial Planning Committee
Trustees
Other

I need transportation from:
Dayton, Ohio Airport
Indianapolis, Indiana Aiport
Other

I need the following meals and accommodations:
Type "Y" or yes in box if you need a meal provided.
Wednesday: overnight
Thursday: breakfast lunch dinner overnight
Friday: breakfast lunch dinner overnight
Saturday: breakfast lunch overnight
Other

Please make my arrangements for lodging at Quaker Hill Conference Center.

I will make my own arrangements for lodging, I am staying at:
Motel:

Please list dietary or other special needs here:

Comments: