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  LAMBDA RECOVERY WEEKEND    
November 2 -4 , 2011    
Camp Stevens, Julian    

                     
November 2ND - 4TH  2012
Lambda Recovery Weekend Registration
$150

Early Bird Discount:  Register by July 31st, $130

50% deposit will be accepted to hold your spot.  In order to complete your registration, LRWSD must receive full payment of any outstanding fees by August 31st.

To apply for a scholarship.  Use the application below.

LRWSD is committed to your right to privacy.  No information provided will be shared with any persons or private party for any reason.
* Required Field
Registered Guest
First Name: *
Last Name: *
Address Street 1: *
Address Street 2:
City: *
Zip Code: * (5 digits)
State:
Phone Number: *
Email:

Lambda Recovery Weekend will use the email and phone number provided to verify registration and for any other future required correspondence.  If you wish for us to contact you at an alternate email/phone number, please list that in the comment section below.
Emergency Contact Information
Contacts Name: *
Relationship:
Phone Number: *
Personalize Your Weekend

What would you like displayed on your Name Tag?

 (First Name?  Nick Name?  Princess?  Diva?)
Would you like to volunteer?
 YES!  Sign Me Up!          No, Thank You.
If YES, please describe
your level of interest?

Do you prefer gender specific
sleeping accommodations?
 Yes.          I don't care, as long as I have a bed.
Gender?
 Male          Female      Transgender

Dietary Needs:

Camp Stevens provides a vegetarian option with every meal. 
Please let us know if you have any dietary needs that you would like us to be aware of.


Are you interested in carpooling?
 YES!  I'm going green!          No, Thank You.

If carpooling,
you prefer:

 I am the driver, and I have wheels.          Passenger please. I want to enjoy the scenery!
 Other Information
Comments:
Please Read
I Agree to
this Statement.
(please enter
your initials )  *		    By submitting this registration, and providing my initials, I release Camp Stevens and Lambda Recovery Weekend of any liability from injury or accident while participating in the 2011 Lambda Recovery Weekend.  I consent that any photographs, artwork, audio, video, or writing submitted may be used by Lambda Recovery Weekend, its assigns or successors, in whatever way they desire in order to continue with Lambda's Mission. You also agree to keep any information obtained through the Lambda Recovery Weekend's function, as it relates to others, personal and confidential.


Payments

Please make your payments to or through paypal.
Lambda Recovery Weekend
1286 University Ave.
San Diego, CA  92103

To pay with your debit/credit card:



Tight on funds?  Apply for a scholarship.

November 2ND - 4TH 2012
Lambda Recovery Weekend
Scholarship Application

Please Note: All applicants awarded a scholarship are responsible for a $75 registration fee

Must be received by:  September 25th

LRWSD is committed to your right to privacy.  No information provided will be shared with any persons or private party for any reason.
* Required Field
Registered Guest
First Name: *
Last Name: *
Address Street 1: *
Address Street 2:
City: *
Zip Code: * (5 digits)
State:
Phone Number: *
Email:
Emergency Contact Information
Contacts Name: *
Relationship:
Phone Number: *
Personalize Your Weekend

What would you like displayed on your Name Tag?

 (First Name?  Nick Name?  Princess?  Diva?)
Would you like to volunteer?
 YES!  Sign Me Up!          No, Thank You.
If YES, please describe
your level of interest?

Do you prefer gender specific
sleeping accommodations?
 Yes.          I don't care, as long as I have a bed.
Gender?
 Male          Female      Transgender

Dietary Needs:

Camp Stevens provides a vegetarian option with every meal. 
Please let us know if you have any dietary needs that you would like us to be aware of.


Are you interested in carpooling?
 YES!  I'm going green!          No, Thank You.

If carpooling,
you prefer:

 I am the driver, and I have wheels.          Passenger please. I want to enjoy the scenery.
Other Information
Please provide a 500 word essay describing your recovery, community involvement and reason for financial assistance.  You may also include any information you feel is important for us to know in reviewing your application.
Please Read
I Agree to
this Statement.
(please enter
your initials )  *		    By submitting this registration, and providing my initials, I release Camp Stevens and Lambda Recovery Weekend of any liability for injury or accident while participating in the 2011 Lambda Recovery Weekend.  You consent that any photographs, artwork, audio, video, or writing submitted may be used by Lambda Recovery Weekend, its assigns or successors, in whatever way they desire in order to continue with Lambda's Mission. You also agree to keep any information obtained through the Lambda Recovery Weekend's function, as it relates to others, personal and confidential.
 

 
Contact:  info@lrwsd.org
1286 University Ave.  San Diego CA,  92103