Workshop Registration Form
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| Name
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| Full Address (street, city, state, zip, country)
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| Street Address
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| Address Line 2
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| City
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| Postal / Zip Code
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| Cell Phone
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| Home Phone
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| Office Phone
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| Email
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| Please indicate which workshop(s) you are interested in attending. You will be contacted by Conger Seminars for payment arrangements.
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Winter Gathering, Zion, IL - January 5-8, 2012
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| What is the best time to contact you?
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| Comments or Questions
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LODGING, MEALS AND TRANSPORTATION INFORMATION
The following sections pertain to seminars hosted by River Highlands Ranch in Smartsville, California
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| LODGING PREFERENCES (all lodging is reserved on a first-come first serve basis):
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I prefer private lodging I prefer private lodging but shared lodging is acceptable I prefer shared lodging I would like to room with a friend
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| Please give us the full name of who you would like to share a room? (if applicable)
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| MEAL PREFERENCES:
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I will enjoy your delicious, regular menu I am a vegetarian I am a vegan I have food allergies
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| Please indicate any food allergies (if applicable)
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DO YOU HAVE ANY SPECIAL NEEDS?
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| Please indicate if you use a wheelchair or will need special assistance
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WHO SHOULD WE CONTACT IN CASE OF EMERGENCY?
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| Include name, phone numbers and relationship to you
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TRANSPORATION REQUEST
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| Will you need transportation to and from the ranch?
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River Highlands Ranch can coordinate a shuttle van to and from Sacramento International Airport. The approximate cost is currently about $90 - $160 each direction. This total cost will be divided equally among the total number of passengers being picked up and will be collected upon arrival at the Ranch.
Note: there will be one pickup from the airport at 2pm on the day the seminar starts. On the last day you will be delivered to the airport in time for a 3pm flight.
If you wish to use this service, fill in this information and submit.
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| Arrival Airline
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| Arrival Flight #
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| Arrival Date
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| Arrival Time
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| Departing Airline
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| Departing Flight #
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| Departure Date
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| Departing Time
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| Number of Bags
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Image Verification
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EMF Contact Form
EMF Contact Form