EVENT REGISTRATION FORM

Download ADULT REGISTRATION ($25) - PLEASE ENCLOSE PAYMENT WITH REGISTRATION FORM. CHILD CARE (BIRTH - 5 YEARS) - MUST SUBMIT HEALTH FORM - CHILD&...

0 downloads 829 Views 105KB Size
EVENT REGISTRATION FORM

2014 Regional Assembly October 17-18 First Christian Church, Garden Grove, CA 11231 Chapman Ave., Garden Grove, CA 92840

REGISTRANT INFO: **Please note that all individuals attending the Regional Assembly must be registered (including young children and youth). Please use a separate form for each individual.

FULL NAME: EMAIL ADDRESS: HOME ADDRESS: LOCAL CONGREGATION: NAME AS TO APPEAR ON EVENT BADGE: PARENT/GUARDIAN IF A MINOR: CHECK ONE: ADULT REGISTRATION ($25) - PLEASE ENCLOSE PAYMENT WITH REGISTRATION FORM CHILD CARE (BIRTH - 5 YEARS) - MUST SUBMIT HEALTH FORM - CHILD’S AGE: KIDS ASSEMBLY (K - 5th GRADE) - MUST SUBMIT HEALTH FORM - CHILD’S GRADE: YOUTH ASSEMBLY (6th GRADE - 18 YEARS OLD) - MUST SUBMIT HEALTH FORM - YOUTH’S GRADE:

CHECK IF APPLIES: VOTING DELEGATE (REGIONAL BOARD MEMBER) - MUST SUBMIT SEPARATE VOTING REPRESENTATIVE FORM VOTING DELEGATE (CLERGY WITH STANDING) - MUST SUBMIT SEPARATE VOTING REPRESENTATIVE FORM VOTING DELEGATE (LOCAL CONGREGATION) - MUST SUBMIT SEPARATE VOTING REPRESENTATIVE FORM

WORKSHOPS (CHECK ONE PER SESSION) FRIDAY MORNING SESSION PostChristian with Christian Piatt Can We Talk? with Mildred Butler, et al Future Ministry with Spencer Burke Boldly Reaching the B-Way with Dale Suggs Hurt 2.0 with BJ Barlow SATURDAY MORNING SESSION PROK in Korean with Kim and Yang Plug-In Required with BJ Barlow (youth only) NBA Explor Young Adults Presentation Soulfull Spirituality with Wolfersberger & Terran Hospitality with Wilfredo Del Pilar 5 Paths to Hospitality with Spencer Burke

FRIDAY AFTERNOON SESSION Immigration with Xose Escamilla Native American Spirituality with Chief Daniel Moral Injury with Matt Harris Gloyer Convergent Worship with Mary J. Scifres Walking in Light with JoAnn Bynum Can You Hear Me Now? With Young Lan Kim

CONTINUED ON BACK

PLEASE CHECK ALL PERTINENT OPTIONS: I PERMIT MY PHOTO TO BE USED BY THE PSWR ONLINE AND IN PRINT OR: I DO NOT PERMIT MY PHOTO TO BE USED BY THE PSWR ONLINE OR IN PRINT I PERMIT MY NAME TO BE PUBLICIZED BY THE PSWR IN RELATION TO THIS EVENT OR: I DO NOT PERMIT MY NAME TO BE PUBLICIZED BY THE PSWR IN RELATION TO THIS EVENT I PERMIT MY NAME TO BE RELEASED TO THE GENERAL CHURCH IN RELATION TO THIS EVENT OR: I DO NOT PERMIT MY NAME TO BE RELEASED TO THE GENERAL CHURCH IN RELATION TO THIS EVENT I REQURE A HEARING ASSISTANCE DEVICE & REQUEST ONE TO BE AVAILABLE AT THIS EVENT I REQUIRE TRANSLATION ASSISTANCE & REQUEST IT TO BE AVAILABLE AT THIS EVENT MY PRIMARY LANGUAGE IS: SPANISH KOREAN ASL

PAYMENT DETAILS: Adult registration costs $25. All child care and programming for youth and kids is free for the 2014 Regional Assembly. Light continental breakfast and lunches are also free. Please submit your payment for adult registration to the Regional Office: PSWR REGIONAL OFFICE 2401 N LAKE AVE. ALTADENA, CA 91001 Make checks payable to “Christian Church PSWR”. In the memo of the check, please denote which registrant(s) the payment is for.

REGISTRATION DEADLINES: Registrations received after midnight October 11, 2014 will be processed on site on the day of the event. Please help us to best organize this event by registering early.