2019 Fall PCD-UUMA Retreat Registration --- Friday, October 25 - Sunday, October 27

It's time to plan for our 2019 Fall PCD-UUMA Minister's Retreat. Registration for the Retreat is now open. Early registration is encouraged! (Registration deadline is September 10th.)

Our Retreat begins Friday, October 25, at 2 p.m. and concludes on Sunday, October 27, with lunch. Our Retreat location is EarthRise at IONS in Petaluma, CA (www.noetic.org/earthrise).

Please be sure to include payment for your 2019-20 dues. Contact the Treasurer - treasurer.uuma.pcd@gmail.com if you are unsure if you have paid your dues.

The Registration Fees for the Retreat are:
$475 Single Room
$365 Double Room
$180 Commuter (2 days, 4 meals)
$105 Commuter (1 day, 2 meals)

(A $25 late fee is added for registrations after September 10th. Rooms are not guaranteed until confirmed by the Registrar.)

Scholarship Deadline: Tuesday, September 10.
A limited number of scholarships of up to $100 per registrant are available. If you need a scholarship, fill out the section at the bottom of the registration from. Please do not pay your registration until you have received confirmation from the treasurer. You may contact her at treasurer.uuma.pcd@gmail.com

Payment Information is repeated after you submit this form.
Make checks payable to PCD UUMA and mail to:
Rev. Alyson Jacks
1187 Franklin Street
Sann Francisco, CA 94109

You can also pay via PayPal at http://www.pcduuma.com/retreats.html after you fill out this form.

Please be sure to submit your registration information, by clicking on the blue "SUBMIT" button at the bottom of this page, before making your payment.

You will receive a confirmation email if your registration submission was successful.

All the best,

Axel Gehrmann
Fall Retreat Registrar

Email address *
First Name *
Your answer
Last Name *
Your answer
Phone where you can be most easily reached *
Your answer
Institutional Affiliation *
Your answer
Please share your pronouns (e.g. she/her/hers, he/him/his, they/them/theirs/ or something else.) *
Your answer
New or Returning Ministers, let us know a bit about you (check all that apply).
Chapter Dues 2019-20
Registration Fee
Arrival & Departure (optional)
If you are attending only a portion of the retreat, please indicate your arrival and departure times. (This allows us to provide an accurate meal count.)
Your answer
Roommate Request (if applicable)
Your answer
Scholarships Fund Contribution (optional)
If you would like to make a contribution for our Scholarship Fund, please enter the amount below, and add to your check.
Staff Gratuity (optional)
Registration includes a 5% contribution to staff gratuity. If you would like to make an additional contribution, please enter the amount below, and add to your check.
GRAND TOTAL (Payment must include registration and chapter dues. If you've made a scholarship donation or additional gratuity, please add this to your total.) *
Your answer
Dietary Information *
Specific food allergies and sensitivities? (EarthRise will do its best to accommodate your needs.)
Your answer
Accessibility Needs?
Your answer
Our chapter welcomes infants who are not yet walking. Please check the box below if you have a baby you plan to bring.
Scholarship Request
A limited number of scholarships are available (up to $100.00) and are awarded on a first-come, first-served basis. Additional amounts may be available in extraordinary circumstances. Contact the treasurer with requests. The scholarship deadline is September 10th. Please check the reason that best describes your request. For those needing a scholarship: If paying by the PayPal/credit card option on our Chapter website, please pay the full amount and the Treasurer will send you a check for the scholarship. If paying by check or bank transfer, please reduce your total amount by the scholarship requested, not to exceed $100. If there are any concerns the Treasurer will contact you.
Untitled Title
Scholarship Amount
Please indicate the amount of your request (not to exceed $100.00)
Your answer
Long Distance Travel Assistance (requests are reviewed by treasurer)
This includes flight travel, bus, train or car rental (assuming there is no one you can share a ride with to the retreat)
Your answer
Please enter in the box below or, for urgent needs relating to registration only, please email rev.axel@uucmp.org
Your answer
Payment Instructions

Make checks payable to PCD UUMA and mail to:
Rev. Alyson Jacks
1187 Franklin Street
Sann Francisco, CA 94109

To pay via PayPal, please visit http://www.pcduuma.com/retreats.html

Late registration deadline is September 10th. If accommodated, late registrations will require an additional $25 fee.

Please note:  After the registration deadline no refunds will be available unless there are people on the waiting list. 

For those needing a scholarship: Please read the information under Scholarship Requests.
For use by registrar only
Date payment received
Your answer
Payment Updates
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This form was created inside of UU Church of the Monterey Peninsula. Report Abuse - Terms of Service