CONFERENCE REGISTRATION
| registration_form.pdf |
2018 INDEPENDENT LUTHERAN DIOCESE 10 YEAR ANNIVERSARY
REGISTRATION FORM
NAME________________________________________________________________
ADDRESS______________________________________________________________
PHONE________________________________________________________________
EMAIL_________________________________________________________________
ACCOMODATIONS REQUESTED (please check each night you are staying)
Private Room $70 Shared Room $35 per person
Tuesday night, October 17th
Wednesday night, October 18th
Thursday night, October 19th
TOTAL ROOM COST $_________ $ ___________
MEALS REQUESTED (please check each meal you are requesting)
Wednesday breakfast ($7.00)
Wednesday lunch ($9.00)
Wednesday dinner ($12.00)
Thursday breakfast ($7.00)
Thursday lunch ($9.00)
Thursday dinner ($12.00)
Friday breakfast ($7.00)
TOTAL MEAL COST $_______
TOTAL COST (room + meals)……………………………………………………………………………………..$_________
Please mail registration form and check made payable to: The Rev. Kevin Low
1103 SE Willow Place
Blue Springs, MO 64080
Payments must be received by September 22, 2017.