REGISTRATION:
$20 NON-REFUNDABLE FEE THROUGH OCTOBER 12.  A limited number of partial scholarships available.  Check the scholarship box below.  
 
Name:  ___________________________________ Age: ______  Gender:  ______
 
Marital Status:  __ single/never married; __ single/divorced __ married; __ divorced/remarried; __ other
 
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 number of the workshops you plan to attend.
I plan to attend the following AM Workshop (number): ___  PM Workshop:  ___
 
___ $20 for registrations postmarked by OCTOBER 18th
___ $17 for attenders of “Partner Churches” before OCTOBER 18th (see list on-line)
___ $27 for attenders of “Partner Churches” after OCTOBER 18th (see list on-line)
___ $30 for late registration after OCTOBER 18th or at the door
___ Additional $35 for Continuing Education Units.
___ $10 for students
___ Free Zumba class over lunch at the YMCA (45 minutes)
___ Free Yoga Stretching class over lunch at the YMCA (45 minutes)
___ I am interested in using the Wabash YMCA Day Pass over lunch or afterwards
___ Yes I would like a partial scholarship.  I have enclosed $_____.
_____ TOTAL amount enclosed