Please return completed form with payment to:

Adopt-an-Activist
PO Box 9363
Santa Rosa CA 95405
707-523-4304
rtcregister@mutualaid.org

Welcome and Check-in will begin at 6 PM on Thursday June 3rd at the Unitarian Hall (1187 Franklin, at Geary), and resume at 8:30 AM Friday morning at the Women’s Building (3543 18th St., off Valencia). Panels begin an hour later (7 and 9:30), and on Sunday at 10 AM.

Updated schedules will be available on-line at www.biodev.org.

Name: ______________________________________________________________________________
Organization/Affiliation:________________________________________________________________
Address: ___________________________________________________________________________
Phone: ___________________________E-Mail: ____________________________________________
How many will be attending? ________________

Conference Registration Fees:

Suggested donations: $5 - $15 (evenings); $10 - $100 (Friday and Saturday). No one will be turned away for lack of funds. Please help us to finance this event by contributing what you can afford.

Enclosed Amount: $ ___________

Make checks payable to Adopt-an-Activist. If you’d like your donation to be tax deductible, make the check payable to the Institute for Social Ecology, with “Biotech/ RTC/SF” in the memo line.

Volunteering:

_____Yes, I am interested in volunteering my time to help make this event happen! I would like to volunteer (please check as many as apply):
_____Prior to the events.
_____At the teach-in
_____ At the Friday evening fundraiser
_____At other Reclaim the Commons events on Sun. – Tues. (specify) ________________________
Do you have any special skills, or exciting ideas for ways to help out?: ___________________________
______________________________________________________________________________
______________________________________________________________________________

Can you offer housing? Do you need housing?:
**Please Pre-Register by May 28th if you would like to be connected with available housing**

We will be seeking home-stays and also larger group housing possibilities. You will need to bring sleeping bags. If you plan on staying in a hotel, or if you have friends in the Bay Area who you would like to stay with, please make those arrangements on your own. There is also an online housing and ride board available at www.reclaimthecommons.net/housing.php. Please access that site for housing information if you can. If not, please fill out the following:

Can you offer housing to out-of-town guests? __________________ How many? _________
Type of accommodations (please check):
Guest room _____ Couch space ______ Floor space _______
Any particular needs/requirements? _________________________________________________

Would you like us to arrange lodging for you?: _________________________________________
For which days?: _____________________________
Your housing preferences: ____________________________________________________________
Any allergies (pets, food, etc): _________________________________________________________
How many people? (please list): ________________________________________________________
________________________________________________________________________________
Would you prefer a smoking or non-smoking housing environment: _____________________________
Any other special needs, concerns or considerations: _________________________________________

Child Care:

**Please Pre-Register by May 28th to reserve child care space for June 4th and 5th. We will attempt to secure child care providers to accommodate those who request child care in advance. **
Names and ages of children who will need child care: ________________________________________
Dates childcare will be needed: ________________________________________________________
Any special needs: _________________________________________________________________

Other Questions/Comments:

Please return completed registration form to:
Adopt-an-Activist
PO Box 9363
Santa Rosa CA 95405
or rtcregister@mutualaid.org