PC (USA) Malawi Mission Network
2009 Face-to-Face Registration Form

MEMBER INFORMATION

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

Travel:

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

Flight # ________________ at Hartsfield International Airport (Atlanta).

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

Flight # ________________  from Hartsfield International Airport (Atlanta).

Will you need a ride from the airport?  ____ YES    ____ NO

I will be driving  and arriving at approximately ______a.m./p.m. on _____________

Lodging:

We encourage you to share rooms but that is strictly up to you - but the price will be more reasonable.    All rooms have private baths.

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: $435.00 ($460.00 after July 13th)

    _____ Double Occupancy Room: $325.00 ($350.00 after July 13th)

    _____ Triple Occupancy Room: $290.00 ($315.00 after July 13th)

    _____ Quad Occupancy Room: $270.00 ($295.00 after July 13th)

    _____ Commuter Registration: $90 ($115 after July 13th):
                 Includes 2 lunches,  3 dinners, 1 breakfast and program expense

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.  If you ask for a triple or quad room, we will do our best but may not be able to match up everyone.