Name:  

   Address:

      Street:  

      City:                State:                Zip Code:  

   E-mail:  

   Phone:         Cell phone:  

   Church (name and location):  

   Emergency Contact Name:  

   Relationship:  

   Emergency Contact Phone:         

   Food allergies? Vegetarian Meal Needed? Other Dietary Restrictions?

   

   Special Needs:  

---

Training Cost: $150 per person

Make checks payable to: Susquehanna Association UCC

Send registration fee to: The Rev. Joseph Connolly
United Church of Christ First Congregational
11 West Main St.
Norwich, NY 13815
607-334-3434
unchurch@frontiernet.net

Deadline to Register: 3 May 2010

---

Submittal Date: