NYYM Summer Sessions Registration for One Adult
Silver Bay YMCA, Silver Bay, NY July 18–24, 2010
BEFORE July 12 return to: NYYM, 15 Rutherford Place, New York NY 10003
AFTER July 12 send to: Silver Bay YMCA of the Adirondacks, 87 Silver Bay Rd.,
Silver Bay NY 12874; 518-543-8833
PLEASE PRINT
Name  ____________________________  Meeting _______________
Street Address ____________________________________________
City  ______________________ State ____________   ZIP ________
Day phone (___) ____________   Evening phone (___) ____________
E-mail address _____________________________________________  
July address, phone, if other than above:  Address__________________
City  ____________ State ____  Zip _____ Phone (___) __________ 
Arrival day & date ___________ Departure day & date ___________
Fee enclosed (see fee chart) $ _____________________________
Donation to Equalization Fund (tax deductible) $ ________________
Check all that apply: 			Worship Groups (check only one):  
 __ Circle of Young Friends (ages 18–35) 	 __ Adults with young children
 __ First time at Summer Sessions	 __ Afternoon (Tues. & Thurs.)
 __ JYM volunteer	 __ Earthcare	 __ General 
 __ Vegetarian	 __ Lesbian, gay, bisexual, transgendered
 __ Do not list me as attending 	 __ Men’s	 __ Racial Healing
 __ Female	 __ Male    	 __ Unprogrammed 	 __ Women’s
Special needs:  __ hearing     __ seeing   __ walking    __ other: __________
I will volunteer for:  __ Golf cart driver  	 __ Microphone carrier
 __ Assisting Friends with special needs	 __ AM Childcare      __ Healing Center
Silver Bay YMCA Housing: 
 __ I prefer the same room assignment as last year
First choice __________________________ Rate: $ __________
Second choice ________________________ Rate: $ __________
 __ If neither is available, location is more important
 __ If neither is available, price is more important
 __ Please assign me a roommate _______________________________
Name of spouse/child/other roommate __________________________
I will sponsor/cluster with  ________________________________
 I want information about on-campus camping
I will stay off-campus at (name/address) _________________________
  __ All meals    Only these meals: ___________________________
Application to NYYM for financial assistance (due 6/25/10)
Source of funds: 	Private 	$ ____________
	Provided by monthly/regional meeting 	$ ____________
	Requested from Equalization Fund* 	$ ____________
	*letter from monthly meeting clerk recommended
By submitting this form, I acknowledge that I have read the NYYM agreements.