VILLAGE DESIGN INSTITUTE

Registration Form

Directions: fields with * must be completed for online submission

1. Fill-out form 2. Print a copy to send with payment Thanks!

Names(s) * :

Organization:

Address:

Phone:

E-Mail * :

Dietary Needs?

Carpooling encouraged:

Can you offer a ride? Would you like a ride?

Payment Enclosed:

YES! I want to participate in this groudbreaking, precedent setting Ecovillage Design event -
	$50 deposit
	$200 ($160 if paid in full by July 1,2005)
	$300 ($240 if paid in full by July 1,2005)

Suggestions? Questions?

Remember to print a copy to send with payment to:

Village Design Institute
PO Box 2233
Bellingham, WA 98225