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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


Housing Preferance


*limited availibility

Are you ordering a t-shirt

Yes No

Shirt size


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


Payment options

Check Paypal Pay when you arrive ($4 fee)


Directorate of Missions, Lubbock Christian University
Copyright � 2005 [Lubbock Christian University]. All rights reserved.
Revised: 07/31/05