Travel Itinerary Form

(Complete and mail or email to the Jurisdictional office by April 21, 2004)

4849 Greenville Avenue Suite 1545 Dallas, TX  75206

scjumc@sbcglobal.net

Name of Delegate ______________________________________________________

Date ________________________    Conference _____________________________

Arrival Date ________________  Time ___________  Airline & Flight # ___________

Departure Date __________________________  Time _________________________