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2009 NA-CCOWE Registration Form

Personal Data

（（（（

Please print

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First Name: __________________________ Last Name: _____________________________ Sex:

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F Age____ Tel: (H)________________(C)_______________________ Address: ___________________________________________________________________ ___________________________________________________________________ E-mail: _____________________________________________________________________ Emergency Contact: (Name) _______________________ (Tel) _________________________ Church Name____________________________________ (Tel)________________________ Church Address_______________________________________________________________ ____________________________________________________________________________ Position in Church_____________________________________________________________ If working in a parachurch organization or secular post:Organizational Name_____________________________ Position_______________________ Name of Spouse, if coming: ________________________ (Need to register individually)

Lodging Arrangement

：：：：

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Roommate request: (Name):_______________________Relation:_________________

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The register will arrange a roommate if there is no request indicated.

Fees: Please Calculate

1. Registration Fee

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US$50

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by August 1, 2009)

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US$70

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after August 1, 2009)2. Room and Board Fees:For 4 nights (11/30 to 12/4) inclusive of mealsPrices listed for shared rooms (please added 25% for single room)Check appropriate box:

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A Room. US$330 (Riverside/Hotel)

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B Room. US$295 (Hillside/Motel)

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C Room. US$260 (Cottage/Inn)3.

Total (add 1 and 2): US$ _______________ and send a check to:CCCOWE–USA PO Box 2005, San Gabriel, CA 91778 or CCCOWE–Canada 3325 Victoria Park Ave. #204, Scarborough, ONT, M1W2R8