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UYWI09 Reg Form - Fall

UYWI09 Reg Form - Fall

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Published by uywi
FAll 2008 version of the UYWI09 Registration form
FAll 2008 version of the UYWI09 Registration form

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Published by: uywi on Oct 02, 2008
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06/16/2009

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HOW TO REGISTER

Online: www.uywi.org Fax:
(877-329-8994)

877-FAX-UyWi

groUP LEADEr - Confirmation of your registration will be sent to this person
CHUrCH / orgANizATioN NAME NAME MAiLiNg ADDrESS ( ® CHUrCH CiTy ® HoME ) E-MAiL

urban youth workers institute 2009

Mail:

Urban youth Workers institute Attn: Registration 6925 Aragon Circle, Ste 6 Buena Park, CA 90620

Register online or postmark by Feb 29 or April 15 to qualify for early rates. Pre-Registration closes Tuesday May 6th. After that, we invite you to register at the door.

Discount Expiration Dates

(

DAyTiME PHoNE

)

ADDiTioNAL ATTENDEES - For more attendees, copy this form or download it from www.uywi.org
NAME MAiLiNg ADDrESS ( ® CHUrCH CiTy ® HoME ) STATE ® CELL) MALE / FEMALE PrEFErrED rooMMATE ziP E-MAiL

( ® HoME

® CHUrCH / org

-

STATE ® CELL) MALE / FEMALE PrEFErrED rooMMATE

ziP

HOUSING ® Thu, 5/14 ® Fri, 5/15 ® Sat, 5/16 ® No Housing

Last Day to Register

Team Rate

Teams of 5 or more from the same church/organization who register together can qualify for the Team rate.

(

DAyTiME PHoNE

)

( ® HoME

® CHUrCH / org

-

HOUSING ® Thu, 5/14 ® Fri, 5/15 ® Sat, 5/16 ® No Housing HOUSING ® Thu, 5/14 ® Fri, 5/15 ® Sat, 5/16 ® No Housing HOUSING ® Thu, 5/14 ® Fri, 5/15 ® Sat, 5/16 ® No Housing HOUSING ® Thu, 5/14 ® Fri, 5/15 ® Sat, 5/16 ® No Housing
$ TOTAL $ $ $ $ - $ = $

Spouse Rate

As a special incentive for couples in ministry, when you signup together, one of you can attend at the Spouse Rate.

NAME MAiLiNg ADDrESS ( ® CHUrCH CiTy ® HoME )

E-MAiL

If you are unable to attend, another youth worker can attend in your place. You can cancel your registration up to may 6th for a refund, less the $50 non-refundable deposit. Cancellations after may 6th are non-refundable.

Cancellation/ Transfer Policy

(

DAyTiME PHoNE

)

( ® HoME

® CHUrCH / org

-

STATE ® CELL) MALE / FEMALE PrEFErrED rooMMATE

ziP

NAME MAiLiNg ADDrESS ( ® CHUrCH CiTy ® HoME )

E-MAiL

Group Registration
The group leader receives all correspondence and is responsible for communication with their group. If members of your group wish to pay individually, we accept multiple checks or credit card payments for your group registration.

(

DAyTiME PHoNE

)

( ® HoME

® CHUrCH / org

-

STATE ® CELL) MALE / FEMALE PrEFErrED rooMMATE

ziP

NAME MAiLiNg ADDrESS ( ® CHUrCH CiTy ® HoME )

E-MAiL

Travel

Read detailed travel information, including available discounts, at

www.uywi.org

(

DAyTiME PHoNE

)

( ® HoME

® CHUrCH / org

-

STATE ® CELL) MALE / FEMALE PrEFErrED rooMMATE

ziP

Location
(West Campus)

Azusa Pacific University The Felix event Center 701 east Foothill Blvd Azusa, CA 91702 UYWI provides continental breakfast on Friday and Saturday, plus Saturday lunch and dinner. There is an on-campus café and many nearby restaurants for meals on your own.

Special Instructions or Coupon Codes:

CALCULATE FEES
Individual Fall Rate By Dec 15th $100 $85 $50 # of Persons x x x x

Team of 5 or more Spouse

Meals

Dorm Housing

$25 x # of nights _______

Total Fees: Registration Plus Housing Amount Enclosed

Options: Pay in Full, or $50/person non-refundable deposit

Balance Due at Check-In
$

Housing

Dorm-Style housing is available on the APU campus on Thu, Fri & Sat nights. Register early to ensure housing availability. Dorm rooms have two twin beds, and linens and towels are provided.

METHoD oF PAyMENT ® Check payable to UYWI….. Amount on check

$

® Credit Card ® Visa ® MC ® Discover ® AmEx

$

AmOUnT OF CHARge

CARDHOLDeR’S nAme

Call with any questions

1-800-rEg-UyWi
(800-734-8994)

CARD nUmBeR

exP DATe 3-DIgIT SeCURITY CODe

/

CARD’S BILLIng ADDReSS ZIP CODe SIgnATURe

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