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Gathering Registration Form |
Please Register Immediately!
The enrollment in this gathering
is limited to 75 men. Please return this form with your deposit. We'll honor the
first 75 registrations received by mail. We do
not anticipate having space for walk-ins.
Please Print:
Date of Gathering____________________
Name_______________________________________________
Address_____________________________________________
____________________________________________________
City__________________________________Zip____________
Phone______________________________ Email __________
Total fee (see below)____________
Amount enclosed____________
Check here if this is your first time with Maine Coast Men ____
Retreat fees cover the cost of workshops, meals & lodging. Each participant will be responsible for a retreat fee and for one work assignment at the lodge (kitchen, firewood, etc.) Proceeds of this money continues to support this weekend as well as the outreach programs of Maine Coast Men.
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If your income is: |
Your fee is: |
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Under $10,000 |
$25.00 |
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$10,000-$20,000 |
$50.00 |
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$20,000-or more |
$75.00 |
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Special Circumstances | |
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Students |
$25.00 |
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Boys (ages 13-18) |
Free |
Please send your full fee along with your registration. If you can't meet the recommended fee, just pay what you can. Scholarship money is available and may be requested by writing us regarding your needs. Make checks payable to Maine Coast Men.
"By my signature on this application, 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 and discharge Maine Coast Men, Tanglewood 4-H Camp, and all persons associated with this event 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________
Send completed registration to:
Maine Coast Men
MCM Wellman P O Box 673
Westminster, Mass. 01473-0673
You may print and mail this page. Upon confirmation, we will send information about Friday night pot-luck, workshops, directions, what to bring, etc.
Last updated 4.8.2007