PC (USA) Malawi Mission Network
2017 Conference Registration Form

Normal Registration Deadline: July 6th 2017
(CLICK HERE TO DOWNLOAD A PDF FORM INSTEAD)

MEMBER INFORMATION

Name: ______________________________________________ Gender: M ___ F___

Address: ____________________________________________

City: _______________________   State: ____________      ZIP: ____________

Phone: ________________________   Cell: _____________________       

Email: ________________________________________

Alternate Address: _______________________________________________

Alternate Phone: _________________________________________

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

Name:___________________________  Relation: _________Gender: M ___ F____

Name:___________________________  Relation: _________Gender: M ___ F____ 

Any dietary or physical special needs?  _____________________________

LODGING INFORMATION:

Attendees are encouraged to share rooms to lower individual conference costs.

Full registration includes 3 nights lodging, all meals (Thursday dinner thru Sunday breakfast) and program expenses

No full registrations can be accepted after July 18th.  Only commuter registrations will be accepted after that date. Late registrants will be responsible for their own lodging accommodations..

Please indicate number of people at each rate below if more than one person is being registered with this form.

    _____ Single Occupancy Room: $491.00/person  ($516 after July 6th)

    _____ Double Occupancy Room: $342.00/person  ($367 after July 6th)

      _____ Commuter Registration - Full Event: $174/person  ($199 after July 6th)
                 Includes 2 lunches, 3 dinners and program expense

    _____ Commuter Registration - 1 Day: $118/person ($133 after July 6th)
                 Includes 1 lunch,  1 dinner and program expense
                 Friday: _______    Saturday: ______

If you are registering for a Double  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. 

TRAVEL INFORMATION

Travel:

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

Flight # ________________ .    I need transportation from the airport.  Y __ N __

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

Flight # ________________     I need transportation to the airport.  Y __ N __

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:  ______

MALAWI MISSION NETWORK INFORMATION

Affiliation:
Congregation Name or other organization represented: __________________________________________

Are you a registered member of the Malawi Mission Network?  __ YES   __NO

Membership is not required to attend.  Conference registration will include registration in the network.

If you are NOT already registered as a member, please tell us what your connection to or interest in Malawi is.. Why are you  interested in attending the conference?

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