PC (USA) Malawi Mission
Network Normal Registration Deadline: July 23rd, 2012 |
MEMBER INFORMATION Name: ______________________________________________ Address: ____________________________________________ City: _______________________ State: ____________ ZIP: ____________ Phone: ________________________ Cell: _____________________ Alternate Address: _______________________________________________ Alternate Phone/Email: _________________________________________ Email: ________________________________________ Gender: M _____ F _____ Other Family Members on same registration form: Name:___________________________ Gender: M ___ F____ Relation: _________ Name:___________________________ Gender: M ___ F____ Relation: _________ Do you have any dietary or physical special needs? _____________________________ Church Affiliation: Are you already registered as a member of the Malawi Mission Network? __ YES
__NO ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ |
Travel/ Lodging Information Travel: 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 ride from the airport? ___ YES ___ NO - (Shuttle available - nominal cost). I will be driving and arriving at approximately ______a.m./p.m. on _____________ -My Travel Plans are not complete yet, but I will notify you when I know: ______ 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. _____ Single Occupancy Room: $420.00/person ($445.00 after July 23rd) _____ Double Occupancy Room: $285.00/person ($310.00 after July 23rd) _____ Triple Occupancy Room: $260.00/person ($285.00 after July 23rd) _____ Quad Occupancy Room: $245.00/person ($270.00 after July 23rd) _____ Commuter Registration - Full Event: $130/person ($145 after
July 23rd): _____ Commuter Registration - 1 Day: $60/person ($70 after July
23rd): If you are registering for a Double, Triple or Quad Occupancy room, who
will you be rooming with: ____________________________ or "assign me as
needed" _______ I will check in on: ____/_____/______ and check out on ____/______/______. |
Total Amount Enclosed: $_________ |
NOTE: If you wish to come early (Aug 21st or 22nd ) or
stay later (Aug 27th or 28th), you may be able
to do so and still get a special rate from Highlands. Contact Jim Nussbaumer for
details.
If you have any questions on registration, please email Jim Nussbaumer at Jim@nussbaumers.net
or call him at: 970-586-2437
Please mail this application along with your check to:
Jim Nussbaumer |
The Registration Fee - (a check) should be made out to: |