Make checks payable to Quaker Center, and mail to:

PROGRAM DIRECTOR
QUAKER CENTER
P.O. BOX 686
BEN LOMOND, CA 95005

Name(s): _____________________________________________________________

Children and age(s): _____________________________________________________

Address: ______________________________________________________________

City and Zip: ___________________________________________________________

Phone: (____) ___________

E-mail: _________________________

___ I/We will arrive for ___________ (meal) on ____________ (day).

___ I/We will leave after __________ (meal) on ____________ (day).

Enclosed, please find my contribution of $ ________ to help defray meal costs.

We have the following special interests and or special skills in:

Special needs and considerations: _________________________________________

Evening program suggestions: ____________________________________________

Diet restrictions: _______________________________________________________

WORKCAMP - REGISTRATION