Malawi Mission Network
2006 Face-to-Face Registration Form

                    Normal Registration Deadline: July 21st, 2006


Name: ______________________________________________

Address: ____________________________________________

City: _______________________   State: ____________      ZIP: ____________

Phone: ________________________            Fax: ________________________

Alternate Address: _______________________________________________

Alternate Phone/Fax/Email: _________________________________________

Email: ________________________________________

Gender: M _____     F _____

Other Family Members on same registration form:
Name:___________________________  Gender: M ___ F____  Relation: _________

Name:___________________________  Gender: M ___ F____  Relation: _________

Name:___________________________  Gender: M ___ F____  Relation: _________

Do you have any dietary or physical special needs?  _____________________________

Church Affiliation:
Congregation or other organization: __________________________________________

Are you already registered as a member of the Malawi Mission Network?  __ YES   __NO
(You are not required to be a registered member to attend. Attending will sign you up for the network.)

If you are NOT already registered as a member, please answer the question below:
What is your connection to or interest in Malawi?  Tell why you are interested in the meeting.






Travel/ Lodging Information


I will arrive on ____/_____/____ at _____________ a.m./p.m. on Airline ____________

Flight # ________________ at Denver International Airport.

I will depart on ___/_____/_____ at _____________ a.m./p.m. on Airline ____________

Flight # ________________  from Denver International Airport.

Will you need a shuttle from the airport ($20 ea round trip- ask for family rate) ?
__YES __ NO  The shuttle will operate on Thursday and Sunday only.

I will be driving  and arriving at approximately _________


We encourage you to share rooms - as the total number of rooms available are limited.  
Each room has 4 single beds with 2 pairs of beds being separated by a common bath.  

Type of Registration: - Full registration includes 3 nights lodging, all meals and program
expenses (indicate number of people at each rate below if more than one person being
registered on one form)

    _____ Single Occupancy Room:  $351.50 ($376.50 after July 21st)

    _____ Double Occupancy Room: $221.50 ($246.50 after July 21st)

    _____ Triple Occupancy Room: $201.50 ($226.50 afterJuly 21st)

    _____ Quad Occupancy Room: $186.50 ($211.50 after July 21st)

    _____ Commuter Registration: $83 ($108 after August 1st): Includes 2 lunches,
                 3 dinners and program expense

    _____ Family member not attending conference (spouse or children):
                 subtract $50 from above rates

If you are registering for a Double, Triple or Quad Occupancy Room, who will you be
rooming with:   ____________________________  or "assign me as needed" _______

If you do not have a preferred room-mate - we will match you up with others as needed
to maximize the room usage and minimize the costs.

I will check in on:    ____/_____/______ and check out on ____/______/______.

Total Amount Enclosed: $_________

If you have any questions please email Jim Nussbaumer at
or call at (970)669-4925

Please mail this application along with your check  to:

    Jim Nussbaumer
   1108 Martin Ct
   Loveland, CO 80537

The Registration Fee  - (a check) should be made out to:  
Mountain View Presbyterian Church
and marked  for "Malawi Network Meeting"