WIC Spring Retreat 2009

	Please fill in this form to register. The red dots indicate required fields.
	First name
	Last name
	Street
	City
	State
	ZIP Code
	Phone
	Email
	Roommate #1 (first & last name)
	Roommate #2 (first & last name)
	Roommate #3 (first & last name)
	FPC Member			Yes No



	1. Registration deadline is January 16, 2009. 2. Cost is $45.00 per person until Dec 31, 2008. 3. Cost is $55.00 per person after Jan 1, 2009. 4. Make Checks payable to FPC and can be mailed/returned to the Christian Education Office (Attn: Omega Stephens).
	Press the button (ONLY One Time!!) to confirm your registration.