Anytown 2010

WHEN
The program will be held Sunday, August 1st through Friday, August 6th.

WHERE
The program will be held at Browns’ Summit Conference Center, located just outside of Greensboro.

COST
The Anytown fee is $400 per participant which include the following: round-trip transportation, all meals, lodging, accident insurance and workshop materials.

A $30 registration fee is due with the application to hold your spot. The remainder of the Anytown fee ($370) is due after you receive your acceptance to the program.

Financial assistance is available to participants based on individual need.

Registration

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Name (First & Last):
Address:
City:
State:
Zip:
Home Phone Number:
Cell Phone Number (optional):
Email Address:
High School:
Grade (FALL 2010):
T-shirt Size:	To ensure ethnic, cultural, gender and religious diversity at Anytown, please provide the following information about yourself:
Gender:
Race:
Religion:
How did you hear about this program?
Why do you want to attend Anytown?
Do you require any specific accommodations for diet or accessibility? If so, please describe.
Parent/Guardian Name:
Parent/Guardian Signature:
Date:
Day Phone Number:
Financial Aid/Scholarship Requested?	Yes No