Registration Form
Please print out this form, fill out it on paper, and mail it in to us.
PLEASE PRINT CLEARLY
NAME: ________________________________________________________
(Last) (First) (Middle Initial)
_______________________________________________
First & Last name for name badge if different from above
_______________________________________________________________
Address
_______________________________________________________________
State Zip Email address
_______________________________________________________________
Daytime Telephone Evening Telephone
WORKSHOPS SELECTION:
(Please indicate first and second choice by workshop number/letter)
Sat. 1:15 – 2:30 p.m.:__________________________________________
First Second
Sat. 2:45 – 4:00 p.m.:__________________________________________
First Second
REGISTRATION FEE
(non-refundable)
$ 50.00 - UNTIL August 22, 2006 $ ___________
$ 55.00 - August 23 – September 18, 2006 $ ___________
MEALS (Optional)
Please indicate special dietary needs
$ 20.00* – Fri.( Buffet), Williams Inn $ _________
$ 5.00* - Sat. Continental Breakfast $ _________
Complimentary: Sat. Lunch Cookout $ ____N/C__
$ 15.00* - Sat. Mission Dinner $ _________
$ 5.00* – Sun. Continental Breakfast $ _________
DONATION $ _________
TOTAL $ ________
(*Price all inclusive)
Checks payable to: Williams College (memo: Haystack Bicentennial)
Send to : Susan Schneski, Registrar
First Congregational Church, UCC
906 Main Street, Williamstown, MA 01267
SPECIAL NEEDS:
Assistance with wheelchairs _____
Visual (large print programs) _____
Saturday Child Care: Number and Ages of children_____/____________
Note: Overnight accommodations are not a part of this registration. For
suggestions see:
http://haystack.williams.edu/bicentennial/accommodations/