Wufoo

Name * First Last
Nametag/Nickname
Birthdate * MM / DD / YYYY
Gender (optional)
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone * ### - ### - ####
Cell Phone (if you have one) * ### - ### - ####
Work Phone ### - ### - ####
Email *
Your profession
Electric outlet needed? If so, please give reason.
Emergency Contact Information - Someone (not on Star Island) we can contact in an emergency. * First Last
Relationship of your Emergency Contact person to you. *
Emergency Contact phone number * ### - ### - ####
Are you:
New to the conference? New to the Island?
Needs:
I need a first floor room
Regular Menu Vegetarian Menu
Per Person Room and Board Rates (Includes room, all meals and ferry transportation) plus $95 per person program fee.

Triple, Double and Single are in rooms in multi-story buildings with shared bathrooms. Motel is a simple room with its own outside door & its own sink & toilet. Motel double is twin beds. Showers are in the main hall (not in bathrooms).
Please choose one: *
Motel single - $455 (+ $95 - total $550) Single (not motel) - $340 (+ $95 = total $435) Double (twin beds) - $275 (+ $95 = total $370) Double (double bed) - $275 (+ $95 = total $370) Motel double - $326 (+ $95 = total $421 Triple - $260 (+ $95 = total $355)
Roommate request - if you sign up for a double or a triple room, you may request specific roommate(s) by name here. If you leave this blank we will assign you a roommate.
Anything else we should know? (You can also contact any time: registrar Peter Amidon - amidonpeter@gmail.com - 802-257-1006.)
After you submit this form you'll get an email confirmation and the opportunity to go to our payment page: http://amidonmusic.com/StarIslandHarmony/payment.html
Do Not Fill This Out