To register by mail, send this form (along with your
payment - make checks payable to "FootFall") to:
 Jerry Blum, 4520 Fidelity Court, Annandale, VA 22003-4525

Please print all your information legibly.
Use a separate form for each attendee.
Confirmation will be sent by email,
 or include an SASE for written confirmation.

Name: _____________________________________________________________

Address:___________________________________________________________ O

___________________________________________________________________

Day phone: ________________________________________________________ O

Evening phone: ____________________________________________________ O

Email: ____________________________________________________________ O

Check the circle next to address, telephone numbers and/or
email if you do NOT want it printed on the attendee list.

For gender balance:
My gender:  O Male  O Female

I am registering with:

____________________________________________________  O Male  O Female

Age/Fee:
 O 14-18        $125
 O 19-25        $150
 O 26 or older  $175

Food preferences:
 O Omnivore
 O No red meat
 O Vegetarian

Housing preferences:
 O Men only cabin
 O Women only cabin
 O Couples only cabin
 O No preference
 O Parent(s) with teenager(s)
 O I plan to tent. (All attendees will be assigned a cabin, as backup.)
 O I would like to share a cabin with:

____________________________________________________________________

Carpooling:
 O I need a ride to/from ___________________________________________

 O I can give a ride to/from _______________________________________