SCM Registration Form

2008 DRIVE IN DAY

Registration Form

Move from one blank to another by pressing the "Tab" key to fill in the blanks. Then print form and mail to registrar with your check made out to NIC UMW (North Indiana Conference United Methodist Women).

First Name:		Last Name:
Address #1:
Address #2:
City:		State: Zip:
Phone No:
E-mail address:

District
Church
Roommate


Check all that apply:		Female Male Clergy Missionary Laity UMW Member District UMW Officer Conference UMW Officer Scholarship Recipient First Time attending UMW Member

Child Care Needed:	Yes	No	Number of children:	*Note: Special needs child must be accompanied by a qualified caregiver.

Overview of all three mission studies will be presented in Cordier Auditorium. Lunch will be served in the College Union.
Complete the following with the appropriate dollar amounts. (See fee schedule)
			Adult		Child
Drive-In Day (with Lunch)
Drive-In Day (without lunch)
Special Health/Dietary Needs:
REGISTRATION DEADLINE JULY 5. Walk-ins welcomed but cannot guarantee lunch ticket.

Mail to: Barbara McCoy, 1025 Brandon Way, Fort Wayne, In 46845

Make checks payable to NIC-UMW.