53rd Weekend Registration Form 2007

Please print and complete one form per person.

Name: _______________________________________________________________

Address:________________________________________________________

City ____________________________    Postal Code______________ 

Phone _____________________  E-mail ________________________________

Parish __________________________________


Some electives are limited in numbers so please choose your first choice and an alternate.
1st choice: ____________________________________ 

Alternate: ____________________________________

I am: Male Female

Age:

Child: please specify age____ 13-19 20-29

30-49 over 50

All children 10 & under will be involved in the "KIDS-I AM A CHILD OF GOD" elective

How did you find out about 53rd Weekend?
Huron Church News/Anglican Journal Clergy/Parish Returning Friend

Fees for programming and meals:

Adult $125.00
Student $100.00
Child (4 - 10) $25.00

Accommodation at Huron University College:

Material Fee:

Art - A Window into Heaven $25.00
Stained Glass $25.00

53rd Weekend Shirts -- Order before April 15!

Denim shirt (Mens, Ladies) $50.00
Golf shirt (Mens, Ladies) $30.00
T-shirt (Mens, Ladies, Child) $18.00
Ball cap $15.00
Sizes: Sm Med Large XLarge XXLarge  Men's Ladies Child

Total fees  $________

Pay by cheque, payable to the Diocese of Huron.
-- or --
Credit card:
Visa    Mastercard     American Express

Card Number: ______________________________

Expiry Date:   _______/_______ (month/year)

Signature:

If you are paying for more than one person: Total Enclosed $ _________

For whom else are you paying? ________________________________________


Accommodation:
I would appreciate a room with my family or friends (please list names): ___________________________________

I am attending for the 1st time
I am returning and I would volunteer. Contact me.
I am attending by myself and would appreciate a contact person / buddy
I will need an interpreter (sign language)
I WILL NEED LARGE PRINT

I have special needs (physical limitations) _________________________________________________________

I have special food needs (allergies, etc) ___________________________________________________________

I have special medical needs (diabetic, etc.) ________________________________________________________


Direct questions, registration forms & payment to the registrar:

Alison Boyd
205 Pineland Court
Waterloo, ON     N2T 2S3
519-884-8841
arboyd @ alumni.uwaterloo.ca

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