Mount Pleasant Presbyterian Church (USA)

FAITH IN 3D

Online Registration

January 16th - 19th, 2009

Walt Disney World Resort

Now through October 1st the cost is $280 pp         October 2nd - October 15th the cost will be $300 pp Included in this package is: Conference, Hotel, Breakfast & Dinner, T-shirt, 3 Day Hopper Pass & Transportation.

Name

Age      Male/Female  MaleFemale    Grade  6th7th8th9th10th11th12thAdult

Address

City    Zip

Yth Ph  Hm Ph

Youth Email

Home Email

Emergency Contact

Emergency Contact Phone

Any Medical Conditions  Yes / No YesNo

If Yes, List them:

Any Medications? YesNo Dosage

If yes, list them

Any Food or Drug Allergies YesNo What are they:

Please remember the the money/deposit is due within 24 hours of submitting this form. If the money is received, your place will not be held.