Number of registrants:	(including kids)
Name(s):
Address, line 1:
Address, line 2:
City:
State/Province:	Select: Alabama Alaska Alberta American Samoa Arizona Arkansas British Columbia California Colorado Connecticut Delaware D.C. Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick Newfoundland New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northwest Terr. Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Is. Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory
Zip/Postal code:
Country:
E-mail:	(Required)
Phone 1:	Select: Home Work Cell
Phone 2:	Select: Home Work Cell
Phone 3:	Select: Home Work Cell
Congregation, Presbytery or other affiliation:

If your registrants include a youth or young adult who wants to be in an age-specific group,

please give the name: and age:

See our detailed writeup about lodging. Some inexpensive housing options are being provided, as available, for out-of-town visitors on Thursday and Friday nights. A nearby Holiday Inn is holding a block of 25 discounted rooms until May 11 (below). For free, you may stay at the church (bring a sleeping bag and pad) and some church members are opening their homes. If you're interested in the free options, please indicate all options that are possible for you, indicating first and second choices for each night:

	Thursday Night	Friday Night
Church floor (gratis)	Select: First Choice Second Choice	Select: First Choice Second Choice
Member’s home (gratis)	Select: First Choice Second Choice	Select: First Choice Second Choice

Commercial options include a Holiday Inn hotel, 2.6 miles south of the church, that is holding a block of 25 discounted rooms until May 11. They can provide shuttle service to and from Midway Airport, provided it is reserved 24 hours in advance. We expect to be able to provide limited transportation from the hotel to the church, and back.

Holiday Inn (Countryside-LaGrange)
http://www.ichotelsgroup.com/h/d/hi/1/en/hd/chilg
6201 W. Joliet Rd.
Countryside, IL 60525-3958
708-354-4200 (Phone), 708-354-4241 (Fax)
Hic6201@aol.com (email)

See our detailed writeup for information on other nearby lodging (but transportation is not guaranteed).

We will provide breakfast, lunch and dinner on Friday, and breakfast and lunch on Saturday. Meals will be simple, with a vegetarian option, but we cannot guarantee to meet special dietary needs. The church prohibits nuts and peanuts due to members with allergies. An offering will be taken to offset expenses.

We will be providing childcare during the scheduled part of the gathering, to the extent possible. If you need childcare, please provide the information below:

Number of kids for childcare:

Child 1, Name:	Age:
Child 2, Name:	Age:
Child 3, Name:	Age:

Other information for childcare providers:

Midway Int'l Airport (MDW) is 8 miles east of the church; O'Hare Int'l Airport (ORD) is 18 miles north. We will try to provide transportation from MDW a few times on Thurs. afternoon / evening, and to it on Sat. afternoon / evening. We may also be able to help arrange some shared rides from ORD. If interested, please provide your travel information (or send it later, when you've made plans).

	Airport	Date	Time	Airline	Flight #
Arrival:
Departure:

Inexpensive mass-transit connections also exist; see the No2Torture.org/ site for more information.

To help with planning, please answer the following question:

What would you like to get from the Gathering to help you work on this issue?

Other comments:

Please when finished or to start over.