Hibernia United Methodist Church in Chester County PA

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Hibernia United Methodist Church
ALPHA Registration Form

Please print this blank form and fill in all requested information.
Return completed Registration by requested date. (Childcare is available.)

NAME: ____________________________________________

ADDRESS: ________________________________________

CITY: _____________________________________________

STATE: ___________________________ZIP: _____________

PHONE: ___________________________________________

E-MAIL: ___________________________________________

* SPECIAL NEEDS *

CHILDCARE: ________________________________________

HANDICAP ACCESSIBILITY: ___________________________

HEARING IMPAIRED: _________________________________

It would be helpful to have an indication of your age.
We try to form the small groups partially on the basis of age.

AGE: ______________

If you would like to come to the Alpha Course, please complete this form and return it to the Hibernia United Methodist Church by requested date. Feel free to invite others, but please complete a separate registration form. Photocopies are acceptable.

If you would like to be with a friend or spouse, please indicate name:

Spouse/Friend:____________________________________________

____ Check here if you would like info on being an ALPHA Course volunteer.

Return Registration Form to:

ALPHA Course
Hibernia United Methodist Church
220 Hibernia Road
Coatesville, PA 19320-1381