QUESTIONNAIRE

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To be completed for each participant and returned with the Registration Form

Name: ___________________________________________

District: __________________________________________

Position: __________________________________________

Lodging: Lake Yale Campus ____ None ____

Name of preferred roommate: _______________________________________

Please specify gender _____ Male ____ Female

If you do not choose a roommate, one will be chosen for you.

Special needs: ____________________________________________________

Special dietary needs: ______________________________________________

Absolutely NO alcoholic beverages are allowed on the property. If any alcoholic beverages

are found in rooms, those participants assigned to the room will be asked to leave after a