Emergence Conference Registration Form

Lutheran School of Theology at Chicago
 1100 East 55th Street
Chicago, IL  60615

The conference fee is $75. This fee covers conference material, a reception on Thursday evening, 2 breakfasts, 2 lunches, and dinner. Please print this form and send together with a check to the address above. Make checks payable to Zygon Center for Religion and Science. You may also fill in the following box if you wish to pay by credit card and mail or send by FAX (773-256-0682). Your registration is valid when you receive confirmation from ZCRS.

For credit card users only: Charge $_______ to my (please circle) Visa or Master Card. Card #: _______________________   Exp. Date: ___________ Name on Card: ___________________    Signature: _____________________

Registration is limited to 50 participants, so please register early.

 

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