REGISTRATION FORM | lavernewebermin

REGISTRATION FORM: (please make copies as needed)

NAME (please print) ___________________________________________

Spouse's Name _______________________________________________

Address _____________________________________________________

____________________________________________________________

Phone Number________________________________________________

Email_____________________Spouse's email_______________________

Costs: Attendee - $50.00; Couple - $90.00; Returning alumni (no manual) - $25.00

Single registration __ Couple registration __ Returning Alumni registration __ (Check one)

Church____________________________________________________

Mail with check to: Rev. Laverne Weber

Faith Community Assembly of God

3000 Freemansburg Ave.

Easton, Pa 18045

For more information:

Telephone: 610-597-4059