Instructions for filling out the form

If you are registering or have registered as a family, please put in the other family member, but fill out a form for each family member separately. Make sure that you fill out all the required fields which are marked with an asterisk. You will not be able to create the pdf file if all required fields are not filled out. If you are paying by Zelle you must fill out the Zelle identifier box. The pdf file name will automatically be your name and the date.

If you are a host or a leader, you will be automatically registered by the PALAC office. Do not register for the group you lead or host.

PALAC Registration Form for Summer 2026

* Required
Member Information
First Name*
Last Name*
Family Membership with (First)
Family Membership with (Last)
Street Address*
City* State* ZIP*
Primary Phone* Type*
 Alternate Phone
Email*
If you are a new member, how did you discover PALAC?
Dues
Dues Selection*
Agreements*
I will be responsible for buying my own books.
If you and your life partner are both registering for the same program(s) do you want to be considered as an inseparable unit for the lottery?
I will share a screen with my partner when registered together?
Multi-Session Programs (Max 3)
ProgramCost
Other Programs (Max 6)
ProgramCost
Totals
Total Programs
Donation
Grand Total
Payment*