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Registration Form for the
Essential Conferences in Mancos
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PLEASE DOWNLOAD THIS FORM AND MAIL TO:
WALDORF EDUCATION ASSOCIATION OF SOUTHWEST COLORADO
P. O Box 1054 Mancos, Co. 81328, PH. (970) 533 -7104
Coordinator:
miriamacquired@hotmail.com

GIVE NAME AND DATES OF THE SUMMER, 2009 CONFERENCE OR WORKSHOP FOR WHICH YOU ARE REGISTERING:

______________________________________________________________________
CONTACT INFORMATION:
Your Name:_________________________________________Gender:______________
Home Mailing Address(with zip code):________________________________________
Phone:________________________Email (please print clearly):____________________
School associated with:_____________________________________________________

EDUCATION/BACKGROUND:
Please list degrees, training, certifications:_____________________________________ _______________________________________________________________________
Please indicate your background or familiarity with Waldorf education:_______________________________________________________________
What grades in Waldorf schools have you taught?________________________________
What grade will you be teaching next Fall?_____________________________________
In preparation for next Fall what area of the curriculum do feel you need the most help with?___________________________________________________________________________________________________________________________________________
Grades you have taught in other (public/private) schools:__________________________

HEALTH/PHYSICAL RESTRICTIONS:
Please list any physical, medical conditions, needs, limitations or any allergies: ________________________________________________________________________
Please list any dietary
RESTRICTIONS (we may not be able to accommodate dietary )preferences:____________________________________________________________
________________________________________________________________________

TRAVEL PLANS:
_____ I will arrive by car; I would like to receive directions by:_____mail; _____email
_____ I will arrive by plane; ______ I request airport pick-up; Airline_______________
Flight #_________, Arrival Time:_______________
I request transportation to the airport for departure on (date, time):__________________
_______________________________________________________________________
NOTE: Flights from Denver to Durango arrive several times a day. Please try to schedule arrival time BEFORE 3p.m. if you plan on pick-up up by our shuttles. Conferences start at approximately 4:00 p.m. of the first date listed. If you arrive
BEFORE the first day of the conference, lodging IS NOT available at Deer Hill.

Payment: I have read and agree to the payment and cancellation policies set forth on the
attached Information Sheet. I am enclosing my deposit:_____/full course fee:_____. Signed:________________________________________Date:____________

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