3RD NATIONAL WITNESSING SUMMIT

Chicago, IL — November 30 through December 2, 2007

Registration Form
Please respond before Nov. 29 by email to Margaret@familyfed.org or by fax: 202-319-3201

Gender: Male Female 1st generation 2nd generation

Name

Honorific First Name Middle Name Last Name

Your Organization:

Your Position:

Mailing Address:
Street Name Suite No.

City State Zip Code

Office Telephone Office Fax Cell Phone

Home Telephone Email Address

Your background in witnessing to college-age young people:

Flight Arrival (Note: arrivals at airports other than O’Hare must arrange their own transportation
to and from the meeting site.)
___________________
Arrival Airport Arrival Date Arrival Time Arrival Airline and Flight #

Flight Departure
___________________
Departure Airport Departure Date Departure Time Departure Airline and Flight #

Single Room
Roommate requested: I will pay an additional $100

Emergency:
Contact Person Name Cell Phone Home Phone

Registration Fee: $120.00 for entire Summit with lodging or $20.00 per day
(or partial day) without lodging. Checks payable to HSA-UWC. Pay at Summit.