Leadership Academy #10 - Registration Form
Deadline for Registration is September 10, 2009
Name:
Address:
City:
Zip:
District:
Church:
Position:
Phone#:
Email:
Please Indicate any Special Concerns:
What specific questions would you like addressed at the Leadership Academy #10:
Preferred Room Mate:
I Have Enclosed:
$150 for Registration
$100 for Single Occupancy Room Thursday
$50 for Double Occupancy Room Thursday
$100 for Single Occupancy Room Friday
$50 for Double Occupancy Room Friday
$25 Late Fee (After Sept. 10th)
Total Enclosed: $
Make Check Payable to:
California Pacific Annual Conference
Print and Mail This Form
Along With Your Check To:
Board of Congregational Development:
First UMC
Attn: Patricia Clever
311 S. Broadway
Santa Maria, Ca. 93454