[Auth] [Session_Start:-Name='AS2_Session',-Expires='1440', -UseCookie] [Session_AddVariable:-Name='AS2_Session', 'sRefNum_Family'] [Session_AddVariable:-Name='AS2_Session', 'sMailName'] AS2 Reg Page 4 Printing

[Inline: -database='AS2_Families.fp5', -table='Web_Portal', -search, -op='eq', 'FamilySN'=(Variable:'sRefNum_Family') ]

All Star II Conference
2005 Registration Form for:

[Field: 'Mailname']          ([Field: 'FamilySN'])
[Field: 'Address']
[Field: 'City'], [Field: 'State']  [Field:'ZipCode']
[Field:'Phone']
[Field:'Email']

Enclosed find a check for $_______, which represents the registration fee & hotel deposit for ___ adults & ___ children (& optional: $ ____ shoalership fund).

[Portal:'GetFamilyMemberInfo'] [IF:(Field: 'GetFamilyMemberInfo::RegistrationCommittment')=='Yes'] [/IF] [/Portal]
Name Relation
-ship
* = New
DOB
Sex
Adult Profession
or Child's Grade
First Name
for Name Tag
 Room Type
Request
Need 1st Floor
Roomate Request
& Housing Needs
Menu
[Field: 'GetFamilyMemberInfo::Name_Full']  ([Field: 'GetFamilyMemberInfo::PersonSerialNumber'])  [Field: 'GetFamilyMemberInfo::Relation']  [Field: 'GetFamilyMemberInfo::Shoaler']  [Field: 'GetFamilyMemberInfo::DOB']  [Field: 'GetFamilyMemberInfo::Sex']  [Field: 'GetFamilyMemberInfo::Profession'][Field: 'GetFamilyMemberInfo::Grade']  [Field: 'GetFamilyMemberInfo::Name4Tag']  [Field: 'GetFamilyMemberInfo::RoomTypeRequest']  [Field: 'GetFamilyMemberInfo::StairsDisability']  [Field: 'GetFamilyMemberInfo::Roomate']
[Field: 'GetFamilyMemberInfo::Housing_Nt']		  [Field: 'GetFamilyMemberInfo::Diet']

Name of Emergency Contact Person: [Field: 'ContactName']        Relationship: [Field: 'ContactRelationship']

Day Phone of Contact Person: [Field: 'ContactDayPhone']         Night Phone: [Field: 'ContactNightPhone']

Day of Arrival: [Field: 'GetFamilyMemberInfo::ArrivalDay']       Portsmouth Boat Time : [Field: 'GetFamilyMemberInfo::ArrivalBoat_TimeOfPortsmouthDeparture']

Is anyone applying to another conference?: [Field: 'ApplyingToOtherConference']        1st Choice: [Field: 'FirstChoiceOfConferences']

Religious Affiliation: [Field: 'ReligiousAffiliation']        If UU or UCC, society or parish: [Field: 'UU_or_UCC_ParishName']

Star Island conference(s) previously attended: [Field: 'ConferencesAndDatesAttended']

How learned about Star: [Field: 'HowLearnedAboutStar']

The Star Island Corporation and the All Star II Conference assume no liability for accidents or illnesses or their treatment. Our first aid station is equipped only for basic treatment in an emergency. For those with special medical needs, please supply the information requested on our medical information page by enclosing it with this registration form.

Signature ________________________________ Date: ____________ [/Inline]