PC (USA) Malawi Mission
Network Normal Registration Deadline:
July 6th 2015 |
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 Detroit Metro 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. No full registrations can be accepted after July 17th. After that date, only commuter registrations will be allowed and you will be responsible for your own housing. _____ Single Occupancy Room: $495.00/person ($520 after July 6th) _____ Double Occupancy Room: $350.00/person ($375 after July 6 th) _____ Commuter Registration - Full Event: $200/person
($225 after July 6th) _____ Commuter Registration - 1 Day: $100/person ($115
after July 6th) 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: ____/_____/_2015_ and check out on ____/______/_2015_. |
Total Amount Enclosed: $_________ |
If you have any questions on registration, please email Kathy Bernard at
bernardfamily2@gmail.com
or call her at: 248-305-8614
Please mail this application along with your check to:
Ailsa Blunk |
The Registration Fee - (a check) should be made out to: |