Pre-Registration closes August 7th. Onsite Registration only after August 7th. You can print this page and then mail or fax the completed form to:
| Western Unity Region P.O. Box 3396 Gresham, OR 97030 |
Fax or Phone: (503) 695-3426 Best hours to call are from 7 am - 6 pm |
Pre-registering - Please pay the full amount or $65 deposit for
each registration. The remainder will be due at the door.
On-Site - Full amount due at the door.
Children - This year's program for children will run concurrently with the adult program. Please register as early as possible.
| Adult________________________________________ | Adult________________________________________ |
| Child's name & age_____________________________ | Child's name & age_____________________________ |
| Child's name & age_____________________________ | Child's name & age_____________________________ |
| Address___________________________________________________________________________________ | |
| City/State/Zip______________________________________________________________________________ | |
| Phone (Day)________________________ | (Eve.)____________________________ |
| E-Mail:_______________________________________ | |
| Church Affiliation/City_____________________________________________________________ | |
T-shirts will be fashioned after the event logo art. SM, MED, LG, and X-LG are $15 each; XX-LG and XXX-LG are $18. Prepayment is required. For further questions please contact the Registrar.
Payment Schedule |
||
| ____ Adults @ $165 | ______ | ____ I am enclosing full payment ____ I am paying by ____Check ____Money Order ____Cash ____ Please charge my VISA/MC #_____________________________ Exp. date_____________________________ Authorized signature_________________________________________ Today's Date________________________ |
| ____ Children @$65 | ______ | |
| ____ Children @ $40 | ______ | |
| ____ T-shirts @ $15* | ______ | |
| ____ T-shirts @$18* | ______ | |
| Total Amount Due | ______ | |
| Balance (due on site) | ______ | |
*T-shirts (mark quantity by sizes)* ____SM ____MED ____LG ____X-LG @$15 ____XX-LG ____XXX-LG @$18. T-shirts must be prepaid.