Rhode Island Men's Gathering 
February 15 - 17, 2008

Enrollment is Limited. Pre-Registration is Required.

Name_______________________________________

Address_____________________________________

City________________________________________

State_________          Zip_______________

Phone__________________   E-mail____________________

If your income is...    Fee...

Under $ 10,000             $  80.00

$ 10,000-$ 14,999        $  90.00

$ 15,000-$ 19,999       $ 100.00

$ 20,000-$ 24,999       $ 110.00

$ 25,000-$ 39,999       $ 120.00

Fee From Sliding Scale_____________

Donation to Scholarships____________

                               Total___________

"By my signature on this application, I indicate that I am 18 years or older and I agree to assume all responsibility for all risk of damage or injury that may occur to me as a participant in this event. In consideration of being accepted as a participant in this event, I hereby, for myself, my heirs, executors and administrators, release from all claims, damages, causes of action ,present or future, known or unknown, anticipated or unanticipated, which result from, or arise out of, or are incident to, my participation in this event."

Signature______________________________  Date ___________

A limited number of partial scholarships are available. E-mail for information, see below.

I would like to lead a workshop______

I prefer vegetarian meals______

Return this form with full payment. Refunds minus a $25.00 non-refundable

handling fee will be made up to seven days before the program begins.

Make Checks Payable to:  RI Men's Gathering

Mail check and registrations to:

RI Men's Gathering

PO Box 41382
Providence, RI 02940

 Fees cover the cost of all workshops, meals, lodging, and custodial

services. Additional information will be sent upon registration. Inquiries