2017 DIOCESAN CONFERENCE OF

YOUTH MINISTERS
PRE-REGISTRATION FORM
Please accomplish legibly (typewritten/in block letters)

Origin (Parish / Youth Organization) Address

A. PARTICIPANTS
1. Parish Youth Coordinator/ Campus Coordinator/ Area Coordinator
•Fr. •Br. •Sr.
•Mr. •Mrs. •Ms.
Surname First Name M.I. Nickname
Title

Complete Mailing Address (with postal code)

Landline (area code, number) Mobile Phone Number E-Mail Address

Years in the Ministry Appointed or Elected Origin of Ministry Life (Lector, Choir, Knights etc.)

2. Parish Youth Leader/ Asst. Campus Coordinator/ Asst. Area Coordinator

•Fr. •Br. •Sr.
•Mr. •Mrs. •Ms.
Surname First Name M.I. Nickname
Title

Complete Mailing Address (with postal code)

Landline (area code, number) Mobile Phone Number E-Mail Address

Years in the Ministry Appointed or Elected Origin of Ministry Life (Lector, Choir, Knights etc.)
 3. Observer

•Fr. •Br. •Sr.

•Mr. •Mrs. •Ms.
Surname First Name M.I. Nickname
Title

Complete Mailing Address (with postal code)

Landline (area code, number) Mobile Phone Number E-Mail Address

Years in the Ministry Appointed or Elected Origin of Ministry Life (Lector, Choir, Knights etc.)

4. Observer

•Fr. •Br. •Sr.

•Mr. •Mrs. •Ms.
Surname First Name M.I. Nickname
Title

Complete Mailing Address (with postal code)

Landline (area code, number) Mobile Phone Number E-Mail Address

Years in the Ministry Appointed or Elected Origin of Ministry Life (Lector, Choir, Knights etc.)

____________________________________ ______________________
Form accomplished by (signature over printed name) Date

Noted by:

Signature over Printed Name

PARISH YOUTH DIRECTOR/ PARISH PRIEST

“Kabataan: May kahuluganako…Bahagiako ng Simbahan at lipunan…May magagawaako.”