I’d like to register for the Sept. 30th Pioneer Valley Relocalization Workshop. Here’s my info:
	First Name:*
	Last Name:*
	E-mail:*
	Address:*
	City:*
	State:*	Zip Code:
	Day Phone:
	Evening Phone:
	Organization:
	I am interested in the following:
	I would like to receive occasional emails from MCHC
	I would like to join a Pioneer Valley Relocalization Network
	I would like to volunteer at the Sep. 30 Workshop
	My organization would like to table during the day (please include your organization’s name in the contact info above)
	To help us plan, please answer the following questions (not binding!):
	I plan to purchase local food at the event
	I plan to attend the whole day
	I plan to only attend in the afternoon
	I plan to only attend Frances Moore Lappe’s talk
	I am likely to attend a breakout session on:
	Local and Sustainable Agriculture & Food Security
	Achieving Justice in Relocalized Communities
	Reclaiming & Redefining Democracy
	Peak Oil, Global Warming
	Sustainable Energy Production & Conservation
	Revitalizing Local Economies
	* required fields