CUMC Summer Retreat Registration 2007

CUMC Summer Retreat Registration 2007 Form
(Please fill one out for each person)
Name:
Age:	Gender: Male Female
Address:
Day Telephone:
Night Telephone:
Email:

Is this your first time attending CUMC summer conference?	Yes No
Have you accepted Jesus Christ?	Yes No
What church are you from, if any?
Are you in:	High School College Career
Are you a light sleeper?	Yes No
Do other people say you snore?	Yes No
Roommate Preference (optional):
Will you be driving?	Yes No
If so, who is in your car?:
If not, do you need a ride?:	Yes No
Will your parents also be attending the conference?:
Emergency Contact Name:
Contact Telephone:

Are you willing make an optional donation for retreat scholarships? If so, enter an amount and include it in the check.
*If you are under 18 years of age, please have your parents sign the consent form and submit it in no later than July 8th.