Add Your Heading Text Here Please enable JavaScript in your browser to complete this form.Name *FirstLastPreferred First NameGender *Age *Select Age18-29 Years30-54 Years55-64 Years65 + YearsEmail *Cell PhoneWork PhoneProfessional TitleYMCA Camp/Branch * Preferred You a YMCA Association *Address *Address Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeSelect All That Apply To You *First Time AttendeeDay CampResident CampProgram DirectorExecutive DirectorAssociate StaffOperations/Office StaffConference/Retreat StaffSeasonal/Part Time StaffWorkshop PresenterKeynote SpeakerPlanning CommitteeT Shirt Size *Select a Shirt SizeSMLXLXXL3XLRegister by 5pm on Friday, December 15th to guarantee shirt size.Is this your first year attending YMCA Campfire?YesNoHow Many Years Have You Attended?Dietary Restrictions / Special RequestsPlease list any allergies, dietary restrictions, disabilities, mobility limitations, or special requests. Please note that not all our buildings have access to an elevator. Will you be attending Pre-Conference CREMLE?YesNoCREMLE packages include lodging for Saturday, January 24th and meals (Saturday lunch and dinner, Sunday breakfast and lunch)Pre-Conference CREMLE registration *CREMLE Single Occupancy (per person) - $220.00CREMLE Single Occupancy - DEPOSIT ONLY - $100.00CREMLE Double Occupancy (per person) - $173.00CREMLE Double Occupancy - DEPOSIT ONLY - $100.00Would you like to register for a Lodging Package or a Commuter Package? *Lodging PackageCommuter PackageLodging Packages are available for those that will stay on site and Commuter Packages are available for those with alternative lodging. All costs below are sold as a package and will not be reduced due to missed nights or meals. Lodging Packages *Campfire Early Bird Rate (Single-Occupancy) - $552.00Campfire Early Bird Rate (Single-Occupancy) Deposit Only - $100.00Campfire Early Bird Rate (Double-Occupancy) - $411.00Campfire Early Bird Rate (Double-Occupancy) Deposit Only - $100.00The Campfire Conference Lodging package includes conference participation, three nights of lodging, eight meals, and snacks. All rates listed are per person. Single-Occupancy lodging packages will not have a roommate. Double-Occupancy lodging packages will have one roommate.Roommate Request *I would like to request a roommateI would like a roommate of the same gender assigned to meRoommate Request *If your requested roommate cancels without replacement, you will be billed the Single Occupancy rate.Commuter Packages *Commuter Conference Package - $260.00Commuter packages include conference participation Sunday-Wednesday and meals from dinner on Sunday, January 25th through dinner on Tuesday, January 27th. Overnight lodging is not included. Total$0.00PayPal Commerce *PayPal CheckoutCredit CardCard NumberExpiration DateSecurity CodeCard Holder NamePay Now
