YDS Summer Conference Registration Form
2011 YDS Summer Retreat
& Activist Conference
August 9-12, 2012
Valley Brook Inn

201 Kingston Ave, Rt. 209 ● Wurtsboro, NY

Full registration includes all conference activities:
• extensive conference materials
• swimming, sports, and movies
• housing in cabins with individual bathrooms
• breakfasts, lunches, & dinners
• party
Sign in to Google to save your progress. Learn more
First Name
Last Name
Email
Phone Number
Address Line 1
Address Line 2
City
State
Zip
School/Community Group
Graduation Date (If applicable)
Organization
Age
Student/Unemployed Youth Rates
Please carefully select the dates of your attendance. The dates cover the days you will be at the retreat. The discounted rates shown are valid for registrations that are made online or postmarked by Monday, July 18th. Full payment or at least a non-refundable $85 deposit must be made or postmarked by July 18th, with the remaining balance to be paid made no later than your arrival at the site. We expect to use all of the available space at Valley Brook Inn so your prompt registration is essential. Please note, no meals will be provided on Thursday. After July 18th a $100 deposit will be required and the higher rates will be in effect.
Clear selection
Working Youth Rates
Please carefully select the dates of your attendance. The dates cover the days you will be at the retreat. The discounted rates shown are valid for registrations that are made online or postmarked by Monday, July 18th. Full payment or at least a non-refundable $85 deposit must be made or postmarked by July 18th, with the remaining balance to be paid made no later than your arrival at the site. We expect to use all of the available space at Valley Brook Inn so your prompt registration is essential. Please note, no meals will be provided on Thursday. After July 18th a $100 deposit will be required and the higher rates will be in effect.
Clear selection
Adult Rate
Please carefully select the dates of your attendance. The dates cover the days you will be at the retreat. The discounted rates shown are valid for registrations that are made online or postmarked by Monday, July 18th. Full payment or at least a non-refundable $85 deposit must be made or postmarked by July 18th, with the remaining balance to be paid made no later than your arrival at the site. We expect to use all of the available space at Valley Brook Inn so your prompt registration is essential. Please note, no meals will be provided on Thursday. After July 18th a $100 deposit will be required and the higher rates will be in effect.
Clear selection
Would you like to apply for a travel scholarship
 Please click on your attendance dates above and see the scholarship application after you complete the form. We expect to have only enough scholarship funds to help those attending the full conference. We will not accept scholarship applications after July 17th.
Clear selection
Car Pooling
A great way to save money on travel is to carpool. Both sides save when gas costs are shared, and YDS encourages conference attendees to look into carpooling from their communities. YDS will help coordinate carpooling efforts for those who fill out the section below.
YDS Member?
Check All that apply
How did you hear about the conference?
Check All that apply
What are the issues that interest you the most?
Any Additional Comments?
Payment Method
Discounted registration rates are only available if paid on-line or post-marked by July 18th. After July 18 a $100 deposit or full payment of the higher rates will be required. (see above)
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms