$30 Non-refundable fee before OCTOBER 14, 2011
$40 Non-refundable fee after OCTOBER 14 , 2011
$45 Non-refundable fee at the door on the day of the event (November 5, 2011)
$15 Student Fee
A limited number of partial scholarships available. Check the scholarship box below.
Name: ___________________________________ Age: ______ Gender: ______
Address: ____________________________ City: ______________ State: ____ Zip: ______
Phone Number: ( ) _________________________Email:__________________________
Church/Address/City: ______________________________________________
How did you hear about this conference? ______________________________
Occupation (if student, are you undergraduate or graduate): _____________
___ First time attending ___ Attended before, how many years? ____
To assist with accommodations, please list the workshop number you plan to attend:
I plan to attend the following AM Workshop: _____ PM Workshop: _____
___ $30 for registrations postmarked by OCTOBER 14th
___ $40 for late registration after OCTOBER 14th
___ Additional $35 for Continuing Education Units.
___ $15 for students
___ $6.50 Box Lunch at EAGLES THEATRE FOR SOUL SURFER MOVIE
___ $6.00 Box Lunch at CHARLEY CREEK GARDENS
___ $6.00 Box Lunch at the WABASH COUNTY MUSEUM
___ $6.00 Box Lunch at the DR. JAMES FORD HISTORIC HOME
___ $6.00 Box Lunch with the ART GALLERIES AND HISTORIC ARCHITECTURAL WALK
___ $6.00 Box Lunch with the COVERED BRIDGES OF WABASH COUNTY EXURSION
Box Lunch sandwich choice:
__ Shaved Ham/Swiss cheese sandwich
__ White meat chicken salad
All box lunches include apple, brownie and bottled water
___ $7.00 DESSERT BUFFET AND CONCERT AT HONEYWELL HOUSE (Limit 55)
___ $8.75 BUFFET IN GYMNASIUM catered by Eugenia’s (unlimited helping of tossed salad, potato
salad, Cole slaw, chili, chicken noodle soup, ham and chicken salad croissant sandwiches, assorted
cookies, and beverage).
___$7.00 ALL YOU CAN EAT SOUP & SALAD BAR- Charley Creek Inn Ballroom (includes bread
and beverage).
___$7.50 YMCA Lunch: Low fat sub, soup, low fat chips, fresh fruit, and beverage.
___ FREE ZUMBA class over lunch at the YMCA, 30 minutes, 12:00pm
___ KID’S DAY OUT ($20/per child) Age and number of Children____________.
___ Yes I would like a partial scholarship which reduces the registration to $10.
TOTAL amount enclosed $__________________
Please make checks payable to: Wabash Friends Counseling Center
Mail to: Wabash Friends Counseling Center, 3563 S. State Rd. 13 Wabash IN 46992