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CCM Cleveland 2006 Registration Form
*Name
*Address
*City
*Province/State
*Postal/ZIP Code
*e-mail
*Phone
*Registration Fee (all inclusive)
CCM Member ($235 U.S./Can. if received by April 30 - add $50 late fee after April 30)
Non-member ($300 - become a member and save)
Student ($75 - includes 1-yr. membership)
Part-time ($75 members and non-members)
Part-time student ($30)
*Lodging at St. Joseph Christian Life Center
Monday and Tuesday
Monday only
Tuesday only
None
Room Preferences
Private bathroom (if available)
Dorm style room with common bathroom
No preference
Roommate
Please assign a roommate
I prefer a private room
I plan to room with:
Name
*Meals
All meals
All meals except Tuesday dinner
Monday dinner
Tuesday breakfast
Tuesday lunch
Tuesday dinner (groups may be dining out)
Wednesday breakfast
Wednesday lunch
Food preferences/restrictions
none
vegetarian
diabetic
Arrival (date, time, mode)
Departure (date, time, mode)
Important: Print this page before sending.
Highlight and print "selection" and select "landscape" under "preferences."
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for communicators from Mennonite and other Anabaptist traditions."
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