PC (USA) Malawi Mission Network
2010 Face-to-Face Registration Form

MEMBER INFORMATION

Name: ______________________________________________

Address: ____________________________________________

City: _______________________   State: ____________      ZIP: ____________

Phone: ________________________            Fax: ________________________

Alternate Address: _______________________________________________

Alternate Phone/Fax/Email: _________________________________________

Email: ________________________________________

Gender: M _____     F _____

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

Name:___________________________  Gender: M ___ F____  Relation: _________

Name:___________________________  Gender: M ___ F____  Relation: _________

Do you have any dietary or physical special needs?  _____________________________

Church Affiliation:
Congregation or other organization: __________________________________________

Are you already registered as a member of the Malawi Mission Network?  __ YES   __NO
(You are not required to be a registered member to attend. Attending will sign you up for the network.)

If you are NOT already registered as a member, please answer the question below:
What is your connection to or interest in Malawi?  Tell why you are interested in the meeting.

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

Travel/ Lodging Information

Travel:

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

Flight # ________________ at South Bend Regional Airport .

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

Flight # ________________  from South Bend Regional Airport.

Will you need a ride from the airport?  ____ YES    ____ NO - (Free shuttle available).

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.

Type of Registration: - Full registration includes 3 nights lodging, all meals (Thursday dinner thru Sunday breakfast) and program expenses (indicate number of people at each rate below if more than one person is being registered on one form)

    _____ Single Occupancy Room: $450.00/person ($475.00 after July 12th)

    _____ Double Occupancy Room: $300.00/person ($325.00 after July 12th)

    _____ Commuter Registration - Full Event: $100/person ($125 after July 12th):
                 Includes 2 lunches,  3 dinners and program expense

    _____ Commuter Registration - 1 Day: $50/person ($65 after July 12th):
                 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.