Registration Form 2009

"The Natural State" Centers for Spiritual Living Young Adult Retreat Ages 18 (and out of high school) to 30 years old Fri – Mon, Sept 4 – 7, 2009 Camp Loma Mar, 9900 Pescadero Rd, Loma Mar, CA 94021 650-879-0223 Registration Information Name Street Address City, State/Province Zip Code/Postal Code Country Phone and Cell Numbers Email Address Birthday Diet (circle one)

Regular

/

Vegetarian

Church/Center (City, State) Emergency Contact Information Name Relationship Phone Number Alternate Phone Number

After receiving your Registration, we will email you a Welcome Packet with directions to Camp Loma Mar and more information about the Retreat. You can visit the Young Adult Website at RSYouth.org/YoungAdults or contact our Advisor, Valery Thompson, for more information at (530) 243-8345 or [email protected]. Payment, make your check out to “RSIYA” EARLY BIRD FEE: postmarked by August 1st - $200.00 REGULAR FEE: postmarked between August 2 – August 31st - $225.00 LATE FEE: received at the Retreat - $250.00 Send Payment and Registration Form to: Valery Thompson, 4684 Oak Glen Dr., Redding, CA 96001 If you would like to support your fellow young adults by contributing to the Scholarship Fund you may include an extra contribution of any amount in your registration payment. OR mail a check made out to “RSIYA” to Rev. Keith Cox, PO Box 16900 Beverly Hills, CA

90209. Your generosity is deeply appreciated!