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2005 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:
Check all that apply: Female                       Male                         Clergy                        Lay
UMW Member          Dist/Conf UMW Officer
First Time Attending   Scholarship Recipient

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:
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: Georgia Mitchell, 8026 Seiler Road, Fort Wayne, IN 46806

Make checks payable to NIC-UMW.