Droppin' the "L" Registration

Droppin’ the “L”
July 10 & 11, 2009

PARTICIPANT INFORMATION
Last Name:		First Name:
Home Address:
City:		State:
Zip:		Phone:
Email:
Date of Birth:		Gender:	Female Male

CHURCH AFFILIATION:
Church you currently attend: I am presently not attending a church
City:		State:
Zip:		Are you attending DtL with a group?:	Yes No

EMERGENCY CONTACT:
Last Name:		First Name:
Relationship to Participant:
Home Phone:		Mobile Phone:
Work Phone:

	REGISTRATION FEE TO BE PAID THROUGH PAYPAL:
	$20 per participant if received by June 22, 2009 $25 per participant if received after June 22, 2009 $30 per participant if registering at the door on July 10, 2009
	Hotel rooms are the participant’s responsibility. Please call a hotel directly for reservations.