Herland Sister Resources

Roman Nose State Park - May 13, 14 & 15, 2005

___ Below are guidelines to help you select an appropriate registration amount. Deadline for pre-registration is May 6th. Please remember that dogs are welcome but must remain on leashes and are not allowed in the dining hall.

Registration fee enclosed (payable to Herland):

___ $15 ___ $25 ___ $35 ___ $45 ___ $60

___ Concert only - $10

Name(s): _______________________ Phone: ________
Address: ________________________________________
City: __________________ State: ________ Zip: _______

email (optional): ________________________________

Sliding Scale Registration Guidelines Based on Income

Single Person Household Pre-Registration

Annual Income Annual Income per person

__ under $6,500 under $13,300 $15

__ $6,500-$13,300 $13,300-$18,000 $25

__ $13,300-$19,500 $18,000-$26,000 $35

__ $19,500-$30,000 $26,000-$50,000 $45

__ over $30,000 over $50,000 $60

( ) I need a scholarship to attend.

( ) I’m enclosing an additional $ _____ to help provide scholarships.
( ) I’m bringing ____ children (girls of all ages and boys under age 10 are welcome).

Please return registration form and check to: Herland Sister Resources, 2312 NW 39th Street, Oklahoma City, OK 73112
A retreat packet with all information will be sent to you.