REGISTRATION FORM

NAME:

______________________________________

ADDRESS: ____________________________

______________________________________

PHONE: _____________________

E-MAIL: _____________________

Name of roommate(s)if you have a preference:

 ___________________________________

(Each room will have two occupants, unless you request more.)

To reserve your room, please send a check or money order for $15 to:

Women in Christ.
P.O. Box 1,
O’Fallon, MO, 63366-0001

The balance of $60 is due by May 15, 2012.

The total amount of $75 includes six full meals and two nights’ lodging.