PERSONAL INFORMATION

First Name		Last Name
City		State (US)	Select One -------------------- International attendee -------------------- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Idaho Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Country		E-mail
CONFERENCE INFORMATION
How did you hear about the conference?		Select One -------------------- Jesus Radicals Forum Jesus Radicals e-mail list Browsing the Internet Infoshop Indymedia Flyer From a Friend The Ellul Forum Other
I will be atending both days of the conference.		Yes   No
Below are the sessions currently available at the conference. In order to plan the space for each session, please indicate which ones you intend to go to below. Friday Events 3 pm — Worship A Foot-Washing Service  4-5:30 pm — Evening Session Anarchism & Christianity Primer  Christian Anarchism in America 6:4-8:15 pm — Evening Plenary Dorothy Day: Portrait of a Catholic Worker -------------------- Saturday Events 9:15-10:45 am — Morning Session Christianitiy and the Nation-State  Imagining a Stateless World 11 am-12:30 pm — Morning Session (continued) Remedying an Unhealthy System of Care   2nd session 2:30-4 pm — Break-out Time Open Forum  Radical Bike Tour  Briefly suggest a topic for the open forum discussion. I will bring my own bike for the bike tour. Yes   No 4:15-5:45pm — Afternoon Session Christianity, Anarchism and Black Liberation  7:15-8:45 pm — Closing Event An Evening of Prophetic Art
HOUSING INFORMATION If you haven't reviewed the housing page, please do so before filling out this section.
Will you need lodging? Yes   No
How many nights will you be staying? Friday night only  Saturday night only Friday and Saturday nights
What kind of lodging would you prefer (if available)? I would like to tent outside  I would like to sleep indoors
MEAL INFORMATION To provide enough food for attendees, we ask that you indicate all of the meals you will share in. Friday dinner Saturday breakfast Saturday lunch Saturday dinner
List any dietary restrictions you have below. (Please note: all meals are vegan.)