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CONFERENCE REGISTRATION

registration_form.pdf
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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.
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