Registration Form

NAME:  ____________________________________________________________________                                                                                          

STREET ADDRESS:  ___________________________________________________________

CITY/ZIP: ___________________________________________________________________

PHONE: ____________________________________________________________________

E-MAIL: ____________________________________________________________________

Please select one:

Vegetarian                               Meat

Fees:

$30.00     Pre-registration by (lunch included) 

$35.00    at door

$10.00     Student fee (must show id, lunch included)

Notes:

· Local housing may be available for participants who are traveling and would like to arrive on Friday night.

· If you have particular dietary needs please let us know and we will try to accommodate.

· If cost would prevent your attendance, scholarships are available.  Contact your local coordinator.

Total Amount Enclosed:   Make checks payable to:   Pax Christi Minnesota

Return by September 1^st to:

Helen Schroeder: 1502 9^th Avenue NE

Rochester, MN 55906

If you have questions: Contact Tim Haskamp at

Phone: (507) 280-7642

email: hunchbacks8@hotmail.com