9th CFC-YFC NORTH AMERICA LEADERS’ CONFERENCE
University of Maryland @ College Park, MD July 25-27, 2003
REGISTRATION FORM
(please print)
PERSONAL Information
Last Name:_________________________ First Name:_________________________
Name to be printed on ID:________________________________________________
Gender:_______________________ Age:_______________________
Street Address:________________________________________________________
City:___________________ State:___________________ Zip Code:_____________
Home Telephone:_______________________ Email:__________________________
Father’s Name:_____________________ Mother’s Name:_____________________
PAYMENT Information
Conference Fee: $140 US Dollars (includes bed and meals)
Deposit: $40 due on April 15, 2003 with registration form
Remaining Balance: $100 due on May 31, 2003
Please mail forms and make checks payable to:
Couples for Christ
Attn.: Conference Registration Committee
c/o Mrs. Marinela Alvero
3515 Rippling Way
Laurel, MD 20724
(301) 776-5762
email: marinelaalvero@hotmail.com
Shirt Sizes: Please circle your size
S M L XL XXL
TRAVEL Information
Transportation Type: Air_______ Bus_______ Car_______ Train
Airline/Bus Name:_______________________________________________________
Note: Baltimore/Washington International Airport (proximity: 25.2 miles; travel time: 36 mins.
Dulles International Airport 40.3 miles // 54 mins.
Reagan National Airport 14.5 miles // 32 mins.
ARRIVAL DEPARTURE
Airport/Terminal
Flight/Bus #
Connecting Flight (if any)
Date
Time
(Please Print)
EMERGENCY Information
Contact Name:_________________________ Relationship:______________________
Phone #:__________________________ Cell/Pager #:__________________________
Family Doctor:_______________________ Phone/Pager #:______________________
Hospital Name:_________________________ Address:_________________________
Medications Currently Taken:______________________________________________
Medications/Items Allergic to:______________________________________________
Physical Activity Restrictions:______________________________________________
CONSENT & RELEASE WAIVER Form
I am the undersigned parent and/or guardian of the child whose name appears below, hereinafter known as “Participant,” and I hereby give my consent for the Participant to attend the 9th CFC-YFC North America Leaders’ Conference in College Park, MD on July 25-27. 2003.
CFC-YFC and its Ministries, organizers and leaders are, therefore, fully absolved and released from any and all responsibility and/or liability that may directly or indirectly arise from or be incidental to the Participant’s attendance, participation and involvement in any and all activities within the scope of the conference. I understand and agree that I hold CFC Youth for Christ, its Ministries, organizers and leaders free and harmless from any liability, costs or damages to any person/s and/or property caused by, arising out of, or incidental to, the Participant’s attendance, participation and involvement in this conference.
By signing below, I certify that all the above information is true and correct to the best of my knowledge, and I fully and voluntarily agree to the above consent and waiver.
__________________________________ __________________________________
Signature of Participant.............................................Signature of Parent/Guardian
__________________________________ __________________________________
Date......................................................................Date