F3 Summit on Community
April 8-9, 1999, Atlanta, Georgia  USA
"Building, Sustaining, and Celebrating Community"

REGISTRATION

Name and Contact info
It's OK to include my name and contact info on the web site
It's OK to include my name but NOT contact info on the web site
Please DON'T include my name or contact info on the web site
Name
'Last' (Surname) 'First' (Given) Middle
,
Name arrangement Western (Given-Middle-Surname)
Eastern (Surname-Given-Middle)
First Name / Nickname (for badge)
Title
Company
AddressPreferred method
City State Country Postal Code
E-MailPreferred method
PhonePreferred method
FAXPreferred method
Event Fee ($US): $233 / night single, $188 / night double, $49 / day without lodging.
Includes dialogue,  meals and lodging
If you are not comfortable submitting this form, you may print it and FAX it to (770) 889-1952, or call (770) 889-5016.
Lodging
Wed 4/7 PM
(for Thur sessions)
Single ($233)
Double ($188)
No lodging ($49)
Thur 4/8 PM
(for Fri sessions)
Single ($233)
Double ($188)
No lodging ($49)
Additional Lodging
Payment Method VISA
Mastercard
AMEX
Credit Card Info
(Will not appear on confirmation)
Card Number
Expiration (mmyy)
Name on card
Billing Address

Questions below are Optional
How did you hear
about the Summit?
What is your major perspective of Community?
Intentional Communities Virtual Communities
Non-Profit Business
Governmental Religious
Other:
Short Phrase describing yourself
Comments
(no carriage returns, please)

You may print this form and FAX it to (770) 889-9825, if you do not wish to submit it online.

Last updated: 03/20/99
bprice@newsalem.com