SAMPLE REGISTRATION FORMS REGISTRATION FORM for

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					              REGISTRATION FORM for “ROOTS HOLD US CLOSE”

May 27-29, 2005 weekend at Canterbury Retreat Center. Two nights lodging, 5
meals (3 Saturday, 2 Sunday) and all workshops/activities
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           “Roots Hold Us Close” Canterbury Retreat Center May 27-29, 2005

Name(s):

(specify if adult/youth, etc.) ___________________________________________

(if youth/child include age) ___________________________________________

                             ___________________________________________

Email address or Telephone number:

Address: __________________________________________________________

City, State, Zip: ___________________________________________________

Congregation:                                      Position: __________________

Vegetarian?                                Special Needs?

Nursery-care needed? _________________________

                           Mail registration form and check for
   $165.00 per adult/$55 youths (13 yrs. and older)/$40 children (Early-Bird price) to
Florida District UUA, Attention: Roots Hold Us Close, 1901 E. Robinson Street, Suite 18,
                                    Orlando, FL 32803

50% Deposit accepted. Early-bird fee good through May 10, 2005 (received by)

Lodging: Hotel-style rooms with two beds (one queen, one twin) – for singles, families
w/children. Please note: The youth and child rates quoted are dependent
upon youth and/or child sharing a room with an attending parent or
guardian.



“Roots Hold Us Close” is for you, for your family and friends. There will be
workshops and fun & meaningful activities for UUs of all ages. Don’t miss this
exciting gathering – a first in Florida.