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Coming Home 2017 Registration

First Name*

Last Name*

E-mail Address*

Phone* (Enter phone number in the format xxx-xxx-xxxx)

Alternate Phone (Enter phone number in the format xxx-xxx-xxxx)

Address

City

State

Zip/Postal Code

Country


REGISTRATION & MEAL SERVICE

Fees include all meals and snacks

(all participants pay the registration & meal fees)

Dietary Preferences
VegetarianVeganGluten FreeOther

Other Preferences (Please be Specific)


ACCOMODATIONS

• Please reserve a room for me at Pacifica's Ladera Lane Campus
YesNo

Select Date(s)
FridaySaturday

Select Room

I'm sharing a room with

 

OTHER ACCOMODATION OPTIONS

• I will be staying at the Best Western Carpinteria Inn
YesNo

• I am making my own arrangements
YesNo


PAYMENT

I will be sending in payment via*
PaypalCheck

 

Once registration form has been submitted, please send payment via check or paypal.

Make Checks Payable to: PACIFICA GRADUATE INSTITUTE ALUMNI ASSOCIATION. Mail to: 801 Ladera Lane, Santa Barbara, CA 93108





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