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Retreat Registration

Fall CCM Retreat, October 26th and 27th 2004, Sterling Virginia

Please print and mail completed form and a check to:

 

Mary Chris Beardsley

CCM Conference Coordinator

10024 Downeys Wood Ct
Burke VA 22015

Registration deadline is September 15th, 2004.

Contact Information

 

Name

 

Street Address

 

City ST ZIP Code

 

Home Phone

 

E-Mail Address

 

_____ Enclosed is a check or money order for $100 family conference registration fee.

_____I am attending alone and have enclosed a registration fee of $75.

Who Will Be Joining Us?

 

 

_____Mom     ____Dad     ____other

 

Please list children by name and age (feel free use the back if you need more room):

 

 

 

 

 

 

 

 

 

 

Total in your party________

 

 

Volunteers?

Any teens interested in volunteering to help out with the little ones, please let us know!

 

 

Teenís Name(s):

 

Age(s):