Online Registration - Winter Quest 2005

Online Registration can be accomplished with the form below. You will be asked to pay your fees using PayPal. PayPal no longer requires you to be a member in order to use their service. Your payment must be received within 24 hours of your registration for it to be valid.

Name for Nametag - Craft name, nickname or other as you wish it to appear on your name tag.

Gender and Age are for statistical purposes.

Emergency Contact - Someone not at Winter Quest. Please give name, address, and phone number that we may use in an emergency.

Registration Fee - Registration fee is $89 plus a $5 cleanup deposit. The deposit will be returned Sunday when the lodge and cabins are ready for the Ranger's inspection. A $20 late fee will be included since it is now after January 15. A waiting list will be maintained if necessary.

Please enter a first name.
'; } if (empty ($lastname)) { $problem = TRUE; print 'Please enter a last name.
'; } if (empty ($tagname)) { $problem = TRUE; print 'Please enter a name for the nametag.
'; } if (empty ($address)) { $problem = TRUE; print 'Please enter an address.
'; } if (empty ($city)) { $problem = TRUE; print 'Please enter a city.
'; } if (empty ($state)) { $problem = TRUE; print 'Please enter a state.
'; } if (empty ($zipcode)) { $problem = TRUE; print 'Please enter the zip code.
'; } if (empty ($phone)) { $problem = TRUE; print 'Please enter a phone number with area code.
'; } if (empty ($email)) { $problem = TRUE; print 'Please enter your email address.
'; } unset ($submit); if (!$problem) { print '

The form has been submitted. Please click on the PayPal button below to complete you payment.

'; $body = "Firstname = $firstname, Lastname = $lastname, Tagname = $tagname, Address = $address, City is $city, State = $state, Zip = $zipcode, Phone = $phone, Email = $email, Gender = $sex, Age is $age, Diet = $diet, Health = $health, Housing = $housing, Comments = $comments, Emerg Contact = $contact, Fri Eve = $frieve, Sat Morning = $satmorn, Sat Afternoon = $satafter Sun Morn = $sunmorn "; $mailto = "dickmerritt@mindspring.com, info@carolinaspiritquest.org, ymasen@bearcircle.net"; mail ($mailto, $subject, $body, "From: $email, CC: tamiab@earthlink.net"); } else { print '

Please correct your data and resubmit.

'; } } else { } ?>
First Name:'; ?>   Last Name:   Name for Nametag:
Address:   City:   State:   Zip Code:

Phone number:   Email Address:   Gender: >Female >Male       Age:

Dietary restrictions:

     Health concerns:

Housing considerations:    

Additional comments:

   Emergency contact:

Enter your workshop choices for each period

Friday Evening >Gift of Pleasure:
Head & Neck Massage		 >Spirit in Rhythm >(free time)     
Saturday Morning >Life Masks >Make Your Oun
Divination Tool: Tarot Cards 		>(free time)     
Saturday Afternoon >Vision Quest in Fabric >Wearing the Zodiac:
Personalized Chart Jewelry		 >(free time)     
Sunday Morning >78 Card Pick-up:
Discovering Tarot Spreads		 >Feng Shui Applications >Hiking in the Winter
Landscape on Park Trails		 >(free time)

or

Your payment must be received within 24 hours of submitting your registration for it to be valid.

For more information, contact the Director, Amy Brann, at ymasen@bearcircle.net or (919) 624-1320.