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 is sent by email, or include 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 is:  O Male  O Female
I am registering with:

___________________________________________________  O Male  O Female

Age/Fee:     O 14-25        $140              Late registration: Add
             O 26 or older  $195                $25 after August 15.
 Kitchen or sweeper scholarships $110 - For information, email us.

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 Parent(s) with teenager(s)
 O I would like to share a cabin with: ______________________________
 O I plan to tent. (You will still be assigned a cabin, as backup.)

 Air Conditioned cabin:   O Yes     O No     O No preference
 Specific cabin: I would like to be assigned to cabin:

 ____________________________________________________________________
 Give location ("near pool"), name ("lodge"), or number(s) ("24").
 See this map of the cabins for locations, names, and numbers.

Carpooling:
 O I need a ride to/from ____________________________________________

 O I can give a ride to/from ________________________________________