Registration information:
Once you register, we will send you a confirmation via email (please note there is a deadline of April 21, 2006). On the day of the workshop, we ask that you stop by the registration table to pick up your registration packet. Please direct all matters of concern to the staff at the registration table.
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REGISTRATION

Deadline: Friday, April 21

Cost: $25 per person

 

Number of Persons Attending:

Total Amount Enclosed:

 

Main Contact Information:

 

Name:

 

Address:

 

City/State/Zip:

 

Phone:

 

Email:

 

Names of others in group:

 

 

 

Medical Professional

            Doctor r

            Nurse r

            Other (please specify)

 

Religious Professional

            Pastor r

            Lay Person r

            Other (please specify)

 

Other Professional

 

Student

            Theology/Seminary r

            Undergraduate r

            Medical r