PLEASE COMPLETE this form AND MAIL your check to the address listed
below. Thanks.
Upon completing this form press the “submit” button at the bottom. After clicking “Submit” a confirmation page will appear on your screen. If this confirmation page does not appear your registration will not be received! If this occurs please contact our office at (724) 463 8422
Delegate Registration Form
2010 ELCMA Annual Appalachian Assembly
April 26, 27, 28, 2010
Riverside Inn, Cambridge Springs, PA
Name
Address
City
State
Zip
Phone
E-mail
DELEGATE representing (Synod, ELCMA Council)
ELCMA Council
ELCA Churchwide Unit
Other Agency
Bringing A guest? (Spouse/ Non–Delegate) please have them fill out a Visitor Form.
Child Care required?
Names and ages of children
Note that child care is provided for the business sessions only. A monetary gift is requested for the caregivers.
Do you have any dietary concerns we can attempt to address?
Commuter (no lodging required, only meals)
Monday
Tuesday
Wednesday
Arriving by PLANE?
Give us this data and we will coordinate a ride from the Pittsburgh Airport. Arrivals must be prior to 10 AM Monday. Departures cannot be prior to 4 PM Wednesday
Monday Arrival Flight #
Time
Wednesday Departure Flight #
Time
Do you need picked up at the Pittsburgh, PA Airport?
Cell number (to assist in connecting with ride)
Room Information
>>>>>NOTE: Single accommodations are in limited supply. Register early to insure availability.
** FYI 2 rooms share 1 bathroom**
Delegates Arriving Sunday night are to cover the cost for the Sunday night room, no meals will be provided until Dinner on MONDAY. ELCMA will cover the cost for a double room Monday night and Tuesday night .
Sunday Night : Single room
$83.00 OR double room
$41.50/night/person
If double room is selected do you have a roommate ?
If ‘no’, a roommate of the same gender will be paired with you.
If yes, please provide the name of your roommate.
If your roommate is a spouse or Not a Delegate please have them fill out a Visitor Form.
Monday Night :
Single room, $41.50
Double room Covered by ELCMA
Double Room Sharing with Spouse or non Delegate Roommate and they have filled out a Visitor Form
Tuesday Night :
Single room, Spouse or NON delegate Roommate $ 41.50
Double room Covered by ELCMA
Double Room Sharing with Spouse or non Delegate Roommate and they have filled out a Visitor Form
Meal Options : Delegates and council members have all meals covered by ELCMA. If your spouse or NON-Delegate Roommate (visitor) is attending they will need to fill out a Visitor Form .
Mon dinner ,Tues breakfast ,Tues lunch , Tues dinner , Wed breakfast
Field trips - no charge
TOTAL please total your cost and enter amount of check being sent
Check here if someone else will be paying your expenses . Name of person/synod/agency
Check here if you are covering the costs for a visitor and paying with one check. Name of Visitor
>NOTE : an additional late fee of $50.00 will be Required for any registration forms received after March 1st 2010!<<
Any other Concerns or questions please list them here:
>>>>>>We will be making reservations for you from this sheet. <<<<<<
Please submit all checks no later than March 01, 2010 to:
ELCMA, PO Box 338, Indiana, PA 15701-0338 or Phone/Fax: 724/463-8422, admin@elcma.org
Upon submitting this form a confirmation page should appear on your screen… if you do not see this confirmation your registration was not received! Please call our office.
NOTE: Further correspondences regarding assembly registration and materials will be sent via
e-mail (in a cost-savings effort) unless you designate otherwise. Please check your e-mail for confirmation of the receipt of this registration form and again when the check arrives at our office. You may at anytime go to our website and access all of the necessary materials for the Assembly as they become available. Thank You!
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