Registration Form
Name: ________________________________________________________________________________
Address:______________________________________________________________________________
City: ________________________________________________State:_________________Zip: __________
Phone:___________________________________________ E-mail:_________________________
Home Church: ___________________________________________________________________________
Parish (if Tenth) __________________________________________________________________________
Conference
Early registration (by Oct 3) attendee(s)____x$15=_______
Late registration (after Oct 3) attendee(s)____x$20=______
Names of attendees:______________________________________________________________________________
________________________________________________________________________________________________
Childcare (for ages 10 and under): Must Register by Oct 3
Friday session number of children:___x$5=____
Saturday session number of children ___x$5=____
Name/ages of children: __________________________
Session they will attend:_________________________________________________________
_______________________________________________________________________________________________
________________________________________________________________________________________________
Total enclosed: $___________