Conference and Reunion August 21 - 23, 2009 Registration Form

Each person or couple attending must complete a registration form.  All those attending must be a member or in the process of becoming a one during the conference.  To become a provisional member, fill out the application on www.familysynergy.org or in the newsletter and include it and the membership fee with your registration.  All provisional members must attend a New Member Orientation while at conference

Registrant No. 1: Name _____________________________________________________ Name you want on name tag __________________________________  Address ______________________________________________________________________ City, State, Zip ________________________________________________________________ Telephone _______________________________ Family Synergy Member? YES ___ NO ___  Email _______________________________________________________________________

Registrant No. 2: Name _____________________________________________________ Name you want on name tag __________________________________ Address ______________________________________________________________________ City, State, Zip ________________________________________________________________ Telephone _______________________________ Family Synergy Member? YES ___ NO ___  Email _______________________________________________________________________

Conference price includes, Sat. & Sun. meals, beverages, entertainment, and all workshops for the
entire 3 day conference. Bed assignments will be made in the order received.
Please indicate with check beside listing for preferred sleeping arrangements:

Dual (with your partner above)
Single

FULL PAYMENT: $140 per person required TO BE POSTMARKED BY July 15

Make checks payable to:
Family Synergy
Print, fill out & mail this form and check to:
Dick Hanna
3283-A San Amadeo
Laguna Woods, CA 92637