Annual CSI Youth Conference
December 27-30, 2006
Theme:  "Together for the Gospel"

 REGISTRATION FORM

Everyone who registers is required to send either the total sum of $118.00 per person or a partial payment deposit to reserve their spot at the conference.  The reason for this is to guarantee that individuals who register will attend the conference.  We do apologize if this is an inconvenience to anyone, but we must provide an approximate number of attendees to  Riverbend Retreat Center at least two weeks before the conference.

Last Name First Name Age Sex Total
TOTAL

Conference Registration Fee (Per attendee) $118.00

Address:
City:
State:
Zip Code:  
Email:
Phone:
Church Affiliation:
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Mail this registration form with your
Full Payment or Early Deposit ( in US funds ) before Dec 9th, 2006. We may not be able to guarantee sleeping rooms after December 9th, 2005.
Please complete the form and mail it to the following address.

Make all Checks Payable to: Riverbend Retreat Center
 
Mail to:  Jiju Mathew
1369 Steeplechase Road
Bartlett, Illinois 60103


Print this form and mail it with your registration deposit