First Name (required)

Last Name (required)

E-Mail Address (required)

Phone (required)

Alternate Phone

Address

City

State

Zip / Postal Code

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MEAL SERVICE

The conference is complimentary and meal service will be provided - We do, however need a 'meal count'.

I am requesting the following meals:
Friday
 Reception
Saturday
 Breakfast Lunch Dinner
Sunday
 Breakfast Lunch

Dietary Restrictions
 Vegetarian Vegan Gluten Free Other

Other Preference (Please be specific)

LODGING & ACCOMODATIONS

Available on a first come, first serve basis - prices are as follows:
Please reserve a room for me at Pacifica's Ladera Lane Campus
 Yes No

Select Date(s)
 Thursday Friday Saturday

Select Room
Single Occupancy ($89 + tax) - one twin or standard full size bedDouble Occupancy ($136 + tax) - two twin bedsCouple Occupancy ($123 + tax) - one standard full size bed, <em>not a queen</em>

I'm sharing a room with

OTHER ACCOMODATION OPTIONS

I will be staying at the Best Western Carpinteria Inn
use promo code 'PONDERINGPEACE2016' for Special Alumni Rate of $99+tax/night
 yes no

I am making my own arrangements
 yes no

PAYMENT

I will be sending in payment via (required)
 paypal check