Form

SAY RETREAT - REGISTRATION FORM 2008
Please Register by: July 1st, 2008
Name: *
E-mail: *
Phone: *
Gender: *	Male Female
Date of Birth:
Name of Church:
Race/Ethnicity:
Communion/Denomination:
Address:
City: *
State: *
Zip code:
Profession/Occupation (if student, which field)
Emergency Contact: (Name, address & contact information) *
If interested in participation in the Talend show, please check off the talent you will be performing:	Dance Music/Song Skit Comedy Routine Other
Travel Information: *
Special Needs: (diet/medical condition)
If you have any questions, please call Ashish Singh 847-414-3438 or Ella Rathod 402-461-5291. For Scholarship eligibility, please email to registration@sayministry.org.