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document.write("2009 DLC Registration Form \n");
document.write("Complete the following information to register for DLC, then click the \"Submit\" button. \"*\" indicates mandatory fields. An acknowledgement will be displayed for verification prior to forwarding. The \"Back\" button on the acknowledgement page is an opportunity to make any corrections. When submitted, a copy will be emailed to your email address listed. \n");
document.write("Note that approval for all attendees will be obtained from that jurisdiction's Executive Officer. \n");
document.write("A SIGNED Medical Release is required to attend DLC. If not mailed ahead of time, it must be faxed or brought to DLC with the participant. No participant can be allowed to attend DLC without a signed Medical Release. You can download the Medical Release by clicking here, or from the website separately or from the acknowledgement page. \n");
document.write("IMPORTANT: All funds for DLC 2009 must be pre-paid. Payment on-site is not permitted. Address mailed payments to: Pacific NW DLC, c/o Oregon DeMolay, 709 SW 15th Avenue, Suite 301, Portland, OR 97215. Please ensure there is sufficient lead time for your payment to be received if you are mailing your payment. THANK YOU! |
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document.write("| Country | \n");
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document.write("| *Status | \n");
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document.write("| *Jurisdiction | \n");
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document.write("| *T-Shirt Size | \n");
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document.write("| Attended DLC Before? | \n");
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document.write("Completed RD? ![\"RD=Representative](\"http://www.pnwdlc.org/cgi-scr"+"ipt/csFormbuilder/images/desc.gif\") | \n");
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document.write("| Highest LCC Completed | \n");
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document.write("| Advisor Phone | \n");
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document.write("Total Registration is $330.00. Indicate your payment options below including any scholarship allowance to total $330.00. |
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document.write("No on-site payments can be received for DLC 2009. Address mailed payments to: Pacific NW DLC, c/o Oregon DeMolay, 709 SW 15th Avenue, Suite 301, Portland, OR 97215 with sufficient lead time to be received prior to DLC 2009. |
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document.write("List needed payment arrangements, scholarship requests, questions, airport or other transportation assistance needed, etc. in the comments box below. |
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document.write("| Comments/Questions/Concerns | \n");
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document.write("| *Emergency Phone | \n");
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document.write(" The registrant is subject to or has been treated for the following CHECKED medical problems, and is receiving treatment under the supervision of proper medical authorities as indicated below. State OTHER MEDICAL PROBLEMS AND ANY MEDICATIONS in the box below: |
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