Application Form for PCD-UUA Leadership School

Mail ASAP — Early Bird by April 30, 2008
All fees due by July 1, 2008

Send completed form & payment to:   Barb Zoellin-Malm
                                                                        PCD Leadership School Registrar
                                                                        597 Morse Ave.
                                                                        Sunnyvale, CA 94085-3653

We recommend the following member to participate in the
2008 Pacific Central District Leadership School: (Please print)

Name ____________________________________________________________________________________________
print name as you wish it to appear on your nametag

Street Address ______________________________________________________________________________________

City, State, Zip ______________________________________________________________________________________

Home Phone (____) _____________________     Work Phone (____) __________________________________________

E-mail ____________________________________________________________________________________________

Sponsoring Congregation & Current Role in Congregation/Society______________________________________________

Length of Membership in this Congregation/Years as a UU ___________________________________________________

On behalf of the above congregation I commit to financial support for the congregant designated above.
Signature of Board President:

_____________________________________________________________________ Date ________________

The total cost for Leadership School 2007 is $1000 and includes all tuition, room, and board for the week.
A $50 early bird discount will be available to registrations received before April 30, 2008

Individual fee -                                      $600     (minimum deposit of $150 required)
Congregational fee -                               $400

Total Fees: $1000                       less Amount Enclosed: _______________     Balance Due: ________________

All fees must be paid by July 1, 2008

Please indicate: I Do Not want my __ address, __ email, __ phone released for PCD records and Leadership
School student rosters.

Dietary request/restrictions ___ vegetarian ___ vegan ___ other (specify) ________________________________________
__________________________________________________________________________________________________
We wish to honor your accommodation preferences or physical needs (e.g. snoring, inability to climb a flight of stairs, food allergies, etc.). 
Please contact Barb Zoellin-Malm, Registrar (bzm@barzoellin.com or 408-739-0487) as soon as possible with any preference you may have.
                                                                                                                                                                                    Revised 11/28/07