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The Beginning Experience of Western North Dakota Weekend Application

Today’s Date: _____________

Beginning Experience City you're attending _________________________

Date of Beginning Experience Weekend applying to attend: ______________________________

Last Name: ___________________ First Name: ____________________________________

Address: _______________________________________________________________________

City: ________________________________ State: ___________ Zip Code: __________________

Home Phone: (____) __________Business Phone: (____) ___________e-mail: ______________________

Male: _____ Female: _____ Religious Affiliation: ___________________Birthdate: ___________

Number of Children: _____ Ages of Children: _________________________________________

Separated _____how long ago? ______________________

Married for how long? _____________ 

Divorced _____ how long ago? ______________________ married for how long? _____________

Widowed _____how long ago? ______________________ married for how long? _____________

Never married ______ 

1. If you're not currently attending Beginning Experience how did you hear about the Beginning Experience Weekend? (Please include names of friends or acquaintances who have attended a B.E. Weekend and / or names of persons you have spoken to about your readiness to participate in a Weekend.)_____________________________________________________________________________________________________ ___________________________________________________________________________________

Or if you found out about Beginning Experience through advertising, Please specify: __________________________________________________________________________________

2.Local Beginning Experience Levels Attended -

Which City?_______________________

Level # : _____ Date: ____________Name of Level Coordinator: _____________________________

 Level # : _____ Date: ___________Name of Level Coordinator: ______________________________

 Level # : _____ Date: ____________ Name of Level Coordinator: ________________________________

3.Are you presently in counseling or therapy? _____ With whom? Name: _______________________ Address: ______________________________________________________________________________

Please obtain a written acknowledgment from your counselor or therapist that you are ready to participate in a B.E. Weekend. This can be mailed directly to the address at the end of this form or included with this application.

4.Do you have any special dietary, health, or medical concerns we should be aware of ? ________________ Please explain: __________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________

5.Do you have friends, relatives, or acquaintances attending this B.E. Weekend ? _____________________ Please list their names: ________________________________________ ________________________________________________ ________________________________________ ________________________________________________

6. The total cost of the B.E. Weekend is $125.00 ( This includes the cost of housing, meals, materials, and dues to B.E. International. No team members are paid. They donate their time, effort, mileage, even long distance calls).

We ask that a $30.00 (non-refundable) deposit be paid with this application.  The balance due may be paid on the B.E. Weekend or you may work out a payment plan at the time of the Weekend.

NO ONE IS TURNED AWAY FROM THE B.E. WEEKEND BECAUSE OF INABILITY TO PAY.  If the cost of the B.E. Weekend is a hardship for you, please talk to one of your local B.E. leaders. Scholarship funds are available or a payment plan can be worked out. At the Weekend, you will be asked for your final payment.    A plea will also be made for additional donations.

We encourage those who can, to give financial support to the Weekend. This additional support is not only used to support B.E. in general, but it is the primary source of our scholarship funds which allow individuals with financial hardship to attend a B.E. Weekend. 
 ______________Enclosed is payment in full. ($125.00)

______________ Enclosed is my $30.00 deposit, the balance is to be paid at the Weekend.

______________ I need information about financing options. Applications are accepted on a first-come, first-served basis. After your application has been processed, you will receive confirmation that you have been accepted to attend the B.E. Weekend. At that time you will also receive a list of items to bring and directions to the Weekend location. Please list any questions or concerns:  __________________________________________________________________________________________ Return this form to:

Beginning Experience of Western N.D.

Corrine Weaver, 306 Grace St. Burlington, ND 58722

If you have questions, call or contact a local B. E. leader

Weekend Coordinator- Corrine @ 701-721-9242

Bismarck- Barb @226-7719

Minot- Marlys @ 701 721 1742

Dickinson- Luci @ 590-1801