PC (USA) Malawi Mission
Network Normal Registration Deadline:
July 15th, 2013 |
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 _______________ Airport . I will depart on ___/_____/_____ at _____________ a.m./p.m. on Airline ____________ Flight # ________________ from ________________ Airport. (Free Shuttle from Ontario Airport available - I DO ____ DO NOT _____ need a shuttle). 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: $570.00/person _____ Double Occupancy Room: $420.00/person _____ Commuter Registration - Full Event: $270/person _____ Commuter Registration - 1 Day: $110/person If you are registering for a Double Occupancy room, who
will you be rooming with: ____________________________ or "assign me as
needed" _______ I will check in on: ____/_____/_2013_ and check out on ____/______/_2013_. |
Total Amount Enclosed: $_________ |
If you have any questions on registration, please email
Janet Wells at
janetwells@sprynet.com
or call her at: 626-355-7721
Please mail this application along with your check to:
Janet Wells |
The Registration Fee - (a check) should be made out to: |