*  Name  

       *  Address 

            *  City  

             *  State  

      *  Zip Code  

       *   Phone   

Check here if you do NOT want your phone number on
the attendees list distributed at the conference 

       *  Church  

         *  Email  

Please check here if this is your first time coming to Family Conference    

  *  Referred by     

___________________________________________

  Please list each registrant individually:
                                                                                       Accommodations                               
 *                                                                1st Choice                                 2nd Choice
Name               Date of Birth  Gender  RMII RMI HM CTGS INN  RL  CMP        RMII RMI HM CTGS INN RL  CMP
                           

                                                                                         RMII=Riverside Manor II, RMI=Riverside Manor I,
                                                                                         HM=Hillside Manor, CTGS=Cottages, INN=Inn,
                                                                                                    RL=Ribe Lodge, CMP=Camping
Age and gender information is required for proper room assignments.
NOTE: Ribe Lodge is currently reserved for youth housing (age 13-18 at time of conference).
Also, unfortunately all the Cottages have been rented and so are no longer available for 2012.
 _____________________________ 
  
2. Optional Information
    
Please list handicapped requirements if applicable:


Please list dietary needs if applicable:


Please indicate if persons in the same accommodations require separate rooms:


If your preferred accommodations are no longer listed
as available please check here to be put on a waiting list.