WMW Registration form

Please provide the following registration information

First Name
Last Name
Middle Initial
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Home Phone
E-mail

Gender

Male Female

Emergency Contact

Name
Work Phone
Home Phone

How will you be getting to the workshop

If Flying provide: Airline, Arrival time, Departure time, and any additional information

Housing

Student Needing housing Student Not Needing housing Sponsor or Speaker

Housing Preferance

Stay in the dorms staying off campus Camp LCU*
*limited availibility

Are you ordering a t-shirt

Yes No

Shirt size

Small Medium Large XL XXL XXXL

Have you served as a missionary? If so, where and how long?

Payment options

Check Paypal Pay when you arrive ($4 fee)