Family SynergyConference Sept. 10 -12, 2010 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 and beverages, as well as the fantasy workshop, 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:

Couple (with your partner above)
Single

FULL PAYMENT: $175 per person or $300 per couple required
TO BE POSTMARKED BY JULY 20.

Make checks payable to:
Family Synergy
Print, fill out & mail this form and check to:
FS Conference Chair
P.O. BOX 3073
HUNTINGTON BEACH, CA 92605-3073