SCM Registration Form

2008 School of Christian Mission

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

SCM
Mission Study:
*Please complete the following with the appropriate dollar amounts. Click here for fee schedule*
Commuter:
Adult			Child/Youth
Single:
Adult			Child/Youth
Double:
Adult			Child/Youth
Special Needs:

If this registration is for CHI-MI-CA, YO-PE-MI-CA, or Child Care, complete the following:
Birth Date:			Grade Completed as of June, 2007:
Name of Parent:
Name and relationship of person accompanying child (if other than parent)
Name of those authorized to escort child to and from child's sessions

Mail to: Barbara McCoy, 260-637-1842 or email barb.mccoy@verizon.net

Make checks payable to NIC-UMW.