Tahquitz Pines Conference Center (map) 55251 South Circle Drive Idyllwild, CA, 92549 United States ✚ gCal ✚ iCal REGISTRATION PACKET Medication and Inhaler Form MIDWINTER Flyer STAFF REGISTRATION FORM Midwinter Staff Registration *This registration form is for midwinter staff only* Midwinter 2017 is from February 17-20 at Tahquitz Pines. Payment must be sent in separately. For questions, please contact your director. Name * Name First Name Last Name Email Address * Phone Number * Phone Number (###) ### #### What is the best way to reach you? * Email Phone Street Address * Street Address Please enter your full address: Address 1 Address 2 City State/Province Zip/Postal Code Country Church * How are you actively growing in your faith/relationship with God? * How have you seen God work in your life recently? * List food allergies, if any: List medications you are bringing, if any: Consent to background check * Do you give your consent to a background check in the event one has not been done in the last three years? Yes No Upon completing this form, please make payment of $180 to PCJC. There is a $50 fee for any cancellations. There are no cancellation refunds after December 31. Thank you!