PSGW 2004 REGISTRATION FORM

NAME:                                      Mail to:  PSGW 2004
                                                     1503 E Street
STREET ADDRESS:                                      Bellingham, WA
                                                         98225-3007
CITY, STATE, ZIP / POSTAL CODE:

PHONE:

E-MAIL:

REGISTER ME FOR:
|_| Session One:   24 July   - 30 July
|_| Session Two:   31 July   -  6 August
|_| Session Three:  7 August - 13 August

 If the session I have chosen is full, I wish to:
   |_| be wait-listed for my session
   |_| try for Session _______.
   |_| be put on the shortest waiting list.
   |_| have my deposit returned.

|_| I haven't attended PSGW before.
|_| Please send me a scholarship application.
|_| I can't attend this year, but add my name
    to next year's mailing list

COMMENTS OR SPECIAL NEEDS (e.g. vegetarian): _____________________

 _________________________________________________________________

 _________________________________________________________________

DEPOSIT

 I enclose $________ Tuition Deposit ($200 per person per session)
                                     ($500 balance due at camp)
 I enclose $________ in addition to my
 deposit as a tax-deductible contribution. (Thanks!)

 The total enclosed is $________ (U.S. funds)