Registration Mountain States Mennonite Conference 2017 Annual Assembly Registration Step 1 of 4 25% How many people are you registering?*Please enter a value between 1 and 10.Name 1* First Last Is registrant 1 an adult or a child?*AdultChildAge*Name 2* First Last Is registrant 2 an adult or a child?*AdultChildAge*Name 3* First Last Is registrant 3 an adult or a child?*AdultChildAge*Name 4* First Last Is registrant 4 an adult or a child?*AdultChildAge*Name 5* First Last Is registrant 5 an adult or a child?*AdultChildAge*Name 6* First Last Is registrant 6 an adult or a child?*AdultChildAge*Name 7* First Last Is registrant 7 an adult or a child?*AdultChildAge*Name 8* First Last Is registrant 8 an adult or a child?*AdultChildAge*Name 9* First Last Is registrant 9 an adult or a child?*AdultChildAge*Name 10* First Last Is registrant 10 an adult or a child?*AdultChildAge* Family Contact InformationFamily Contact Name* First Last Family Contact Phone Number*Family Contact Email Address* Emergency Contact InformationEmergency Contact Name* First Last Emergency Contact Phone Number*Other InformationAny health concerns?If you need an epi pen, where would we find it?Home Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Congregational AffiliationAre you a delegate from your congregation?*YesNoMealsPlease register for meals. Ponderosa does not make extra food and cannot accommodate persons without a meal reservation. Please note – no dinner on Friday night; eat before you arrive at camp or bring your own food. The camp is nut-free and offers gluten free options.* Saturday breakfast, 7:15 am Saturday lunch, 12:15 pm Saturday supper, 5:15 pm Sunday breakfast, 7:15 am Sunday lunch, 12:15 pm Need a vegetarian option Please select the option below if you will not eat at Ponderosa. No meals at Ponderosa Please tell us if you have food allergies: LodgingWhen are you staying?*Friday night onlySaturday night onlyBoth Friday and Saturday nightsWill not be staying at PonderosaPlease indicate your 1st choice for accommodations:*RVTent CampingDormitoryCabinPrivate roomPlease indicate your 2nd choice for accommodations:*RVTent CampingDormitoryCabinPrivate roomSunday OnlyIf you are planning to just come for Sunday to attend worship and/or eat lunch, you must make a reservation for lunch.* Sunday morning worship at 10:00 AM Sunday lunch Please select the below option if you are not attending ONLY on Sunday. N/A Child CarePlease let us know when you will need child care and indicate age(s) of child(ren) if you do. Saturday morning worship Saturday delegate session Saturday evening worship Sunday morning worship Age(s)ActivitiesHere is a list of activities. Unless otherwise indicated, everything is free. Please mark activities you plan to attend.* John McCutcheon concert, Friday, 7:00 pm Prayer walk, Sunday, 6:45 am Informal Music Jam, Saturday evening, 9:00 pm Mini-golf, $2/person Outdoor sand volleyball Outdoor basketball court Indoor gym for basketball/volleyball Game room Horseshoe pits Gaga ball pit Tetherball Four square courts 9 square in the air court 20 hole disc golf course Hiking High Ropes Course & Zip Line, $20/person, Saturday 1:30-3:30. (Available for persons age 14 or older. Parents must sign a release form for children under 18. Release forms will be available on site or click here for form. Children without a parent must bring the release with them.) Please select the option below if you do not plan on attending any activities. None What instrument are you bringing?* FeesCome if you can. Pay what you can. Pay more if you can. Guideline amounts for determining value of your package: Amount Item $40 per site RV Site – full hook up (water, sewer, electricity) $25 per site RV Site – limited hookup (water & electricity) $8 per person Tent Camping $29 Dormitory 6 years and older per night. 5 and under no charge. $38 Dorm lodging single night weekend stay $85 Private Room $8 Breakfast 6 yrs + $6 Breakfast 3-5 yrs $9 Lunch 6 yrs.+ $7 Lunch 3-5 yrs $10 Dinner 6 yrs + $8 Dinner 3-5 yrs How much would you like to donate? Total $0.00 When you click "Submit," you will be redirected to a PayPal payment page for the amount entered above. You can use a PayPal account OR a standard debit/credit card to complete the transaction (you don't need a PayPal account to continue!). Please put "Annual Assembly" in the optional note field when paying.