* 1. Do you want to attend the 2017 International Urantia Conference in Denver, Colorado?  Select all that apply.

* 2. What is your name?

* 3. How long have you been reading the Urantia Book?

* 4. Please give your contact information, phone #, email, mailing address, and country.

* 5. Who are the Urantia leaders in your area?

* 6. Are you willing to create a 3-5 minute video of Urantia activities in your area?  This would be shared at the IC17 conference and would be needed by June 1, 2017.

* 7. Can your local readers have a Urantia conference at the same time IC17 is happening in Denver July 19-23 2017 and possibly live stream via computer?

* 8. Are you involved in a study group?

* 9. How are you involved with other Urantia Book readers in your area?

* 10. What service activities have you done that are Urantia Book related?

* 11. Which group are you a part of?  Please choose all that apply.

* 12. Please describe areas you are willing to volunteer for IC17:

* 13. Which languages do you speak?

* 14. Please check one or more of the following:

* 15. Estimate your cost for the visa in US dollars

* 16. Estimate your costs for travel in US dollars

* 17. Estimate your cost for conference/meals/lodging in US dollars.
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We will consider a scholarship towards the least expensive registration of $450 for 1 adult on campus at Denver University, July 19-23 2017. 
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If you require more expensive lodging you will need to cover the additional cost.  Please visit the website (IC17.org) to see the full range of food and lodging choices.

* 18. How much money can you contribute toward your total cost for IC17?

* 19. Do you have people who are willing to help you financially in some way from your home town or country?

* 20. Deducting your contribution from the total cost, what is your scholarship amount needed in US dollars:

* 21. Have you attended a Urantia conference before?

* 22. What airport do you fly from?

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