NOTE: This page is formatted for printing on most any printer. You can also contact Mary Marino for applications, email damoremarino@hotmail.com.
Instructions: To be registered, you must complete all sections including the
Liability Statement and return with your check (US funds only) made payable to
Portland Avatar Meher Baba Group.
Mail to:
Connie Klemm, Registrar
1953 NW Irving # 102
Portland, OR 97209
Please print clearly:
Pre-Registration Registration
Postmarked by by July 7 from July 8
-------------- ---------------------- -----------
Ages:
Adults 25 and up $ 75 $ 85
Seniors 70 + 50 65
18-24 and
F/T students 50 65
9 - 17 45 55
2 - 8 25 35
Adults: Name Amount
___________________________________ $________
___________________________________ $________
___________________________________ $________
___________________________________ $________
Children: Name Age
_________________________ _________ $________
_________________________ _________ $________
_________________________ _________ $________
_________________________ _________ $________
I want to help others attend
with my donation of $________
I need Financial Assistance/Work Program [________]
TOTAL Amount enclosed: $________
LIABILITY STATEMENT
I/we agree to release and hold "Baba House", Jim and
Jean Wilson, and the Portland Avatar Meher Baba Group
(together the "Sponsor") harmless from any and all liability
in the event of an accident. All persons using the
premises assume the risk of injury to themselves
and/or their children. The children's crafts and play
program and/or paid babysitters shall not be construed
as childcare. Parents retain responsibility for their
children at all times. I (we) further agree to
indemnify Sponsor for any attorney fees and/or costs
involved in defending itself from any actions for
injury occurring on the premises.
I grant Sponsor permission to act in whatever way
necessary to care for myself and/or my children in
case of emergency, including permission for myself
and/or my children to receive medical treatment.
o ALL ATTENDEES MUST BE LISTED ON REGISTRATION FORM.
o ALL ATTENDEES 18 AND OVER MUST SIGN BELOW.
o ALL ATTENDEES UNDER 18 MUST HAVE THE SIGNATURE OF
A PARENT OR LEGAL GUARDIAN.
Signature of attendee or responsible party date
___________________________________ _________
___________________________________ _________
___________________________________ _________
___________________________________ _________
Address: _________________________________________
________________________________________________
Phone: day ________________ eve _________________
E-Mail ___________________________________________
Special Medical or Other Needs [for information only]:
________________________________________________
________________________________________________
REGISTRATION - Part 2
Names in party:
____________________________________________________
____ # tent spaces needed to camp on-site at
Baba House (Reserve Early)
____ I/we understand special dietary or other needs
are my responsibility.
____ I/we plan to utilize the Childrens crafts and play
area for ___# of children.
Re: Visitors who need to be picked up or need to
stay in Portland overnight, contact:
Jo Hussey email: new_paradigms@bigfoot.com
____ I/We need housing ____ I can provide housing
____ I/we need a ride ____ I can provide a ride
from airport, bus,
or train station.
I'll arrive:
date/time: location: flt (or other) #:
_____________ _______________ _________________
____ I will provide work during part of the Sahavas
in exchange for part of the registration cost.
____ I would like to Volunteer for:
___Car Pooling ___Parking ___Set-Up
___Meals ___Clean-Up ___Where Needed
___Prep Work in May or June at Baba House
(contact Jim Wilson 503-873-2048)
___I would like to coordinate Car Pooling
from Portland to Scotts Mills
(call Jim or Jean Wilson 503-873-2048)
___________MEAL SELECTIONS______________________
Please help keep costs down for everyone. Indicate
if you want meat in a specific meal. Portions of
meat will be purchased according to your selections.
We ask you to follow-through on the options you choose.
Mark number of persons for choices made.
Friday Dinner-Taco Salad: Veggie-Only with Chicken
Number age 11 to adult ____ ____
Number age 3 to 10 ____ ____
Saturday Lunch-Sandwiches: Veggie-Only with "Lunchmeat"
Number age 11 to adult ____ ____
Number age 3 to 10 ____ ____
Saturday Dinner-Indian Buffet: Veggie-Only with Chicken
Number age 11 to adult ____ ____
Number age 3 to 10 ____ ____
Sunday Breakfast Buffet: Veggie-Only with Ham or Sausage
Number age 11 to adult ____ ____
Number age 3 to 10 ____ ____
MAIL REGISTRATION FORM
with completed Liability Statement, to:
Registrar
1953 NW Irving #102
Portland OR 97209
CONTACT INFORMATION: When you have questions...
General Information:
Mary Marino, Co-chair damoremarino@hotmail.com
Registration and Financial Assistance
Constance Klemm constanceklemm@yahoo.com
Out of Towners Transportation Coordination or
overnight housing in Portland
Jo Hussey johussey@spiritone.com
Childrens crafts and play program:
Malini Raffo 503 598-8460
Pertaining to Baba House, Parking etc.
Jim Wilson 503 873-2048
PO Box 38, Scotts Mill, OR 97375
jimmythewilson@hotmail.com
On-Site Volunteer Coordinator
Joanna Tompkin circlemo@m.al8.com